Appointment of Treasurer_Kristi Johnson_11/29/2017 DPOINTMENT OF CAMPAIGN TREASURER RECEIVED
NOV Z 9 2017 y �r
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES VILLAGE CLERKS OFFICE
(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. OFFiut usE ONLY
1. 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) 3. Address (include post office box or street, city, state, zip
V_V_lSTI 7Ek4N=01-,j code)
4. Telephone 5. E-mail address
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6. Office sought(include district, cI cuit, group n ber) 7. If a candidate for a nonpartisan office, check if
VIL4,4A4(, * -T6QU6i1(1} 000Vr'k L, %%W[ 5 applicable:
❑ My intent is to run as a Write-In candidate.
8. If a candidate fora 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.
have appointed the following person to act as my lu Campaign Treasurer Deputy Treasurer
j. Name of Treasurer or Deputy Treasurer
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11. Mailing Address 12. Telephone
13. City 14. County 15. State 16. Zip Code 17. E-mail address
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18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank 20.Address
SeAcO AS'� !12 21. City 22. County 3.�ate 24. Zip Code
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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 26. Signature of Candidate
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27. Treasurer's Acceptance of Appointment(fillin the blanks and t check e appropriate block)
I, 1✓��S'Z� ,�1�1.wos �tiOJ� do hereby accept the appointment
(Please Print or Type Name)
signated above as: Campaign Treasurer Deputy Treasurer.
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Date Signatur6 o Campai n T-r6qfrer o eputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.