HomeMy WebLinkAboutAppointment of Treasurer_Harrison Vaughn_10/22/2020RECEIVED
,,qPOINTMENT OF CAMPAIGN TREASURER
OCT 2 l 2020
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
VILLAGE CLERKS OFFICE 1,,,
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(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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code),
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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
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
Q Write -In Ey_�No Party Affiliation ® Party candidate.
eve appointed the following person to act as my Campaign Treasurer Deputy Treasurer
j. Name of Treasurer or Deputy Treasurer ,
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11. Mailing Address
12. Telephone
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13. City
14. County
15. State
16. Zip Code
17. E-mail address
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18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank
20. Address
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21. Ci�
22. County
23. State
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 THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
26. Signatur oflandiclate
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I,�►� Vt 5M V" L", , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Q----'Campaign Treasurer Deputy Treasurer.
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Date Signature of Campaign Treasurer or Deputy Treasurer
n
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
OFFICE USE ONLY
RECEIVED
OCT 2 2 20201
VILLAGE CLERKS OFFICE `
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candidate for the office of Coy^-w' ��
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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Signature of Candidate
Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84 (05111)
SUNSHINE LAW INFORMATION Sunshine
COUNTY ETHICS ORDINANCE Ethics
I acknowledge that I have received all the forms and documents referenced on this the 2020 List of Candidate
forms and I acknowledge that the information contained here is intended as a reference guide only. The Clerk's
Office will assist candidates; however, performs a ministerial function and cannot interpret Florida Statutes or
dete w ether the contents of the qualifying papers are accurate.
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(Candidate Signature) Date
❑ Candidate Declined to sign acknowledging he/she received the forms.
Clerk Signature:
A
Witness:
RECEIVED
OCT 2 2 2020
VILLAGE CLERKS OFFICE
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