Appointment of Treasurer_Steve Okun_10/25/2017 PPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN OCT 2 5 2017
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. OFFICE 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
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4. Telephone 5. E-mail address
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6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
�vaGS applicable:
�`,, �T 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 Campaign Treasurer Deputy Treasurer
1 U. Name of Treasurer or Deputy Treasurer
11. Mailing Address 12. Telephone
13. City 14. County 15. State 16. Zip Code 17. E-mail address
18. 1 have designated the following bank as my Primary Depository F1 Secondary Depository
19. Name of Bank 20. Address
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21.zwz
y 22. County 23. to 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 FACTS ST N IT ARE TRUE.
25. Date 26. a of C n da
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27. •�T,reeas{ureerr's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, � 1 1�y�.-- OK�V13 do hereby accept the appointment
(Please Print or Type Name)
signated above as: Campaign Trea rer Depu 7asurer.
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Date re of mpaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.