HomeMy WebLinkAboutAppointment of Treasurer_Molly Young_11/16/202010 'POINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
RECEIVED
DEPOSITORY FOR CANDIDATES
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(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
VILLAGE CLERKS CFFICE �j
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
M 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) I3,D 'V-1Vt"- 0('�Q f
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4. Telephone
5. E-mail address
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
v (<<o�sC' 4 -rC_VQSAa , co�Lco Se-
applicable:
0 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
@^1, Write -In No Parry Affiliation ® Party candidate.
ave appointed the following person to act as my f---A Campaign Treasurer Deputy Treasurer
J. Name of Treasurer or Deputy Treasurer
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11. Mailing Address
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12. Telephone
13. City
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14. County
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15. State
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16. Zip Code
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17. E-mail address
18. 1 have designated the following bank as my .j Primary Depository Secondary Depository
19. Name of Bank
20. Address
21. City
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22. County
23. State
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24. Zip Code
69c��
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
X
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, do hereby accept the appointment
(Please int or Type Name)
designated above as: M Campaign Treasurer Deputy Treasurer.
C
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
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OFFICE USE ONLY
RECEIVED
NOV 13 20e0
VILLAGE CLERKS OFFICE �• �_ _ „ 1
a
candidate for the office of
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X
Signature of Candidate
ate
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)
APPOINTMENT OF CAMPAIGN TREASURER
301xWOSAW3103E)V111A
AND DESIGNATION OF CAMPAIGN
Q7t�7 0 7 AON
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S. )
a3nI3038
(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 iA Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
% o1`� ���i ��t� to �
code)
lab D( .
ue.�Ao-,
4. Telephone
5. E-mail address
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.
9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address
12. Telephone
390- �
13. City
14. County
15. State
16. Zip Code
17. E-mail address
r
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank f ; 16
20. Address
I I V C o` jh q
J 1
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 Candidate _
27. Treasurer's Acceptance of Appointment (fill in the blanks and chec(the appropriate block)
I, Mn `1(/ dLo-__� , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
Date Sign ture of Ca aign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
166E E
NOV1 u 2020
VILLAGE CLERKS OFFICE
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
determine whether the contents of the qualifying papers are accurate.
randidate'Signir
I Candidate Declined to sign acknowledging he/she received the forms.
Clerk Signature: Witness:
Date