Loading...
06082022 Amended DS-DE 9 RECEIVED City Clerk's Office APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN JUN 0 8 2022 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) Title:! CAi.� ClizrIC (PLEASE PRINT OR TYPE) By: ►-► Vv � - NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): Initial Filing of Form Re-filing to Change: Treasurer/Deputy El Depository 0 Office El Party 2. Name/of Candidate,(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip code)i ja /4.40 ipso „u‘,...)6 Ai? e:_/- 4. Telephone 5. E-mail address g 3 6-76 17; )39e /KS i it wh�t/reu ra./( 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: /Yla 1J .71_4 /4/ 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 El Write-In 0 No Party Affiliation ® Party candidate. 9. I have appointed the following person to act as my El Campaign Treasurer j2c Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer - / / IC M. //CZ- 11. Mailing Address . 12. Telephone /US 770 /U�.t) ‘L� y'CI C�" (973 )3W /,/,5-3 13. Ci 14La unty 15. State 16. Zip Code 17. E-mail address zir (a4i f-of f z .9.O76 4(a lice (6 /)441 {-orr 18. I have designated the following bank as my El Primary Depository 0 Secondary Depository 19. Name of Bank 20. Address 21. City 22. County 23. State 24. Zip Code 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 / .s/2-,)._ 26. Signature of Cand. ate X S� ,27. urer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I, R/(7 lay c /ic-r°° , do hereby accept the appointment (Please Print or Type Name) designated above as: ❑ Campaign Treasurer A Deputy Treasurer. /.gA '1.- Campaign Treasurer or De ut Treasurer ate Signature ofp y DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.