HomeMy Public PortalAboutAppointment of Campaign TreasurerAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1.
X
CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office Party
2. Name of Candidate (in this order: First, Middle, Last)
Bill Moore
3. Address (include post office box or street, city, state, zip
code)
4409 Hoffner Avenue
STE #403
Orlando, FL 32812
4. Telephone
(407 ) 680-3670
5. E-mail address
bill@votebillmoore.com
6. Office sought (include district, circuit, group number)
City Commissioner, District 1
7. If a candidate for a nonpartisan office, check if
applicable:
My intent is to run as a Write -In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write -In ❑ No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my ❑ Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Bill Moore
11. Mailing Address
4409 Hoffner Avenue, STE #403, Orlando, FL 32812
12. Telephone
( 407 ) 680-3670
13. City
Orlando
14. County
Orange
15. State
FL
16. Zip Code
32812
17. E-mail address
bill@votebillmoore.com
18. I have designated the following bank as my
X
Primary Depository ❑ Secondary Depository
19. Name of Bank
Chase Bank
20. Address
5189 S. Conway Road
21. City
Orlando
22. County
Orange
23. State
FL
24. Zip Code
32812
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
July 21, 2021
26. Signature of Candidate
X ____.
17,...,7
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Bill Moore , do hereby accept the appointment
(Please
designated above as:
July 21, 2021
X
Print or Type Name)
Campaign Treasurer ❑ Deputy Treasurer.
X -c" y"�L Ja.
Date Signature of Campaign Treasurer or Deputy Treasurer
Rule 1S-2.0001, F.A.C.
DS -DE 9 (Rev. 10/10)