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Appointment of Treasurer_Vince Arena_11/2/2017 PPOINTMENT OF CAMPAIGN TREASURER RECEIVED AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES 1,110V 0 2 2017 (Section 106.021(1), F.S.) VILLAGE CLERKS OFFICE '' II `7 (PLEASE PRINT OR TYPE) ' I S NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. ECK 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 �J�06e(v a code) 45 " 4. Telephone 5. E-mail address TLv1� �� ^L 316� J (Sby > ��D�t�yyy FIt1C1�H�SC��a.c or*� 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if 1011a � 1 �` ` aPPlicable: l-J ❑ 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 [�J' No Party Affiliation ❑ Party candidate. have appointed the following person to act as my [[/]^ Campaign Treasurer ❑ Deputy Treasurer 1 u. Name of Treasurer or Deputy Treasurer el, 11. Mailing Address 12. Telephone yb-S—\-Go . ©e. r1CzC� S`�A�r 1._ 33y1OR ( SID) ) ST-co L\4`4 13. City 4. Coun 15. State 16. ZipCode 17. E-mail address w�� , R, 6yU�9 v7r4cyi s5C=0- Sk)Q Qat,com 18. 1 have designated the following bank as my a Primary Depository ❑ Secondary Depository 19. Name of Bank n 20. Address TGI)1a,_v�) DIZ 21. City 22. ounty 23. State 24. Zip Code '�lzi�00�IA xrl 6rWa 'FLOC-tiOA 3-q loq 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 �\N ' 26. lt�ur :� n a TTX ��UUU"'"��"�� 27. Treasurer's "Acceptance of Appointment(fill in the blanks and check the appropriate block) ��I, v � 0T v W)r, do hereby accept the appointment (Please Print or Type Name) 5ignated above as: d Campaign Treasur Depu asurer. a, ao-) X Date Signature of CWmpaign Treasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.