HomeMy WebLinkAboutAppointment of Treasurer_Frank D'Ambra_10/18/2019RECEIVED
APPOINTMENT OF CAMPAIGN TREASURER
OCT 1 8 2019
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):
R 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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code) 3? S �cat�2 0 •u�, l�y�• 3oZ
4. Telephone
5. E-mail address
(S6t) (07�6 _536(A
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6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
applicable:
❑ 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
❑ Write -In ❑ No Party Affiliation ® Party candidate.
I have appointed the following person to act as my 21 Campaign Treasurer ❑ Deputy Treasurer
— Name of Treasurer or Deputy Treasurer
11. Mailing Address
5 �eo,c i� �A,. }'• 362
12. Telephone
(6 ) 67(0 -5 3 0
13. City �
14.
. County
c4frl lead,
15. State
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16. Zip Code
fZ 4 611
17. E-mail address
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18. 1 have designated the following bank as my LI Primary Depository ❑ Secondary Depository
19. Name of Bank
CA �4nL
20. Address
T .
21. Ci
2 County
23. Stat
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 1D�(� ?ol 4
26. Signature of Candidate
27. Treasurer's Accepts f Appointment (fill in the blanks and check the appropriate block)
I, I �0�. do hereby accept the appointment
(Please Print or Type Name)
signated above as: [jrCampaign Treasurer ❑ Deputy Treasurer.
toll Q Imo► Q .
Date Signature of Campaign Treasurer or Deputy Treasurer
IDS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
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