HomeMy WebLinkAboutAppointment of Treasurer_Kyle Stone_11/12/2020APPOINTMENT OF CAMPAIGN TREASURER
RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
NOV } 12020
(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
HECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: 0 Treasurer/Deputy ❑ Depository ❑ Office 0 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:
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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.
' ave appointed the following person to act as my Campaign Treasurer N' Deputy Treasurer
j. Name of Treasurer or DeputyTreasurer
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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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331447
449
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18. i have designated the following bank as my 2 Primary Depository Secondary Depository
19. Name of Bank
20. Address
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21. City
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. Signature of Candidate
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
i, 4�`� ��L , do hereby accept the appointment
(Please P i or Type Name) Y
designated above as: Campaign Treasurer Deputy Treasurer.
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ll - IZIZ�Lo X - <96-,,�
Date Signature of Campaign Treasurer or Deputy Treasurer
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
I , 4`'e- S�r6 ne-
candidate for the office of
OFFICE USE ONLY
RECEIVED
NOV } Z 2020
VILLAGE CLERKS OFFICE
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
Signature of Candidate
it- IZ -Zoto
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 (05/11)
SUNSHINE LAW INFORMATION
COUNTY ETHICS ORDINANCE
Sunshine
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
determine whether the contents of the qualifying papers are accurate.
(Candidate Signature)
Date
❑ Candidate Declined to sign acknowledging he/she received the forms.
Clerk Signature: Witness:
RECEIVED
NOV I Z 2020
VILLAGE CLERKS OFFICE