HomeMy WebLinkAboutAppointment of Treasurer_Tom Paterno_11/6/2018 RECEIVED
APPOINTMENT OF CAMPAIGN TREASURER NOV - 6 2018
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. 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
{—
14o•>„n� Co-r-z.&, code) 3_17 f=vC& bAJveL
4. Telephone 5. E-mail address —1 LS T/i r''L 3 3 �{-!C7
( 015y) Gn—?67� htr-
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
C0 NCB 5 1�_ ❑ 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.
9. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or D uty Treasurer
11. Mailing Address 12. Telephone
3 a7 b >` 1���cs %� �L 33Ki9 (95y )
13. City 14. County 15. State 16. Zip Code 17. E-mail address
T-a Vt. rA Pff-t-w, at*,- G r;i - 33Wo7 +PA-TtwecS,Bt(4;wr".NF)r-
18. 1 have designated the following bank as my � Primary Depository Secondary Depository
19. Name of Bank 20.Address
21. C 22. County 23. State 24. Zip Code
it1f IL V t zr4 3 3 �
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 Can 'dat
1►� � �a�� X -
27. Treasurer's Acceptance of Appointment(fill in the blanks ao check the appropriate block)
1, (0-1-Z1i"^o , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer De ut T jeasurer.
Date Signature f Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.