HomeMy WebLinkAboutAppointment of Treasurer_Bruce Prince_11/13/2019LPPOINTMENT
RECEIVED
OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
NOV 13 2019
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
VILl.ACX 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. ¢HECK 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 pffice box or stre t, city, state, zip
Sr✓ee �. Prf'v)ce
code) 70 Fit ►� � tee• w s
-Te7 FI '
4.
Telephone
5. E-mail address
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( W) ,? r%-'T b %
rp ry >!^ee
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
vn���l
applicable:
❑ My intent is to run as a Write-in candidate.
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8. If a candidate fora 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 Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
t'uG t r tI N C-t
11. Mailing Address
12. Telephone
70 FAyotecJ e-s 7
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13. City
14. County
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15. State
16. Zip Code
33 �16 41
(17. E-mail address %
eJ�r�
! J►3 //rl
D r r N t f Mr ! t V
1871 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank
20. Address
21.��City
22ou�ty
23. State '
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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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X
27. Tre surer's 6ceptance of pointment (fill in the blanks and check the appropriate block)
r
1, ,SrJ C,e r t A t 'C , do hereby accept the appointment
7
(Please Print or Type Name)
:signated above as: Campaign Treasurer ® Deputy Treasurer.
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/Daiel Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.