HomeMy WebLinkAboutAppointment of Treasurer_Laurie Brandon_10/18/2019-,PPOINTMENT OF CAMPAIGN TREASURER
RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
OCT 18 2019
(Section 106.021(1), F.S.)
VILLAGE CLERKS OFFICE
(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
( , ate ✓� ICi c�od � d
code) I rJ (sDlTl�l lc-ti �t�
4. Telephone
5. E-mail address-Cc�)lt�
Q% I ) 70-7 -I qpq
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6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
2
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
U Write -In No Party Affiliation ® Party candidate.
I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
— Name of Treasurer or Deputy Treasurer
11. Mailing Address
12. Telephone
1 `?- S -C>,/-, TeQ 33`I (i.
(5ri () 707 I qQV
13. City
14. County
15. State
16. Zip Code
17. E-mail address
LIC i a e a co
18. 1 have designated the following bank as my Primary Depository ❑ Secon ary Depository
19. Name of Bank
20. Address
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5 Ln ''
21. City
22. County
23. State
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 /
26. Signature of tindidate
—Z V1 2
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
/
1, L Al& ILL e 9 t%60 CLIl1 do hereby accept the appointment
(Please Print or Type Name)
signated above as: �ampaign Treasurer ❑ Deputy easurer.
CI �I s'/I 9 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.