Appointment of Treasurer_Jessica Namath_11/9/2023 APPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES NOV - 9 2023
(Section 106.021(1), F.S.)
VILLAGE CLERKS OFFIC
(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: 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,
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zip code)essic� &r^Ce I��� LA
4. Telephone 5. Candidate's Voter Registration#: 2-0CI ,0 vh A Jy
(5�► ) 2z�-�-a� ! 14 ,�1I l u 4 24 Fi,
(Not required for Qualifying Purposes)
(Not required for Qualifying Purposes)-Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on
the audio ballot as may be used by persons with disabilities(see instructions on page 2 of this form):
NAY - wi±b
6. Office sought(include
,district,
lcircuit, group number) 7. If a candidate for a nonpartisan office, check if
19 l�il C I �'C�/�15 applicable:
V y
M 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
Write-In 12(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. Telephone
J�ssi CA N ayo Aih (6u i ) 9Z2qq31
12. Mailing Address 13. City 14. State 15. Zip Code
16. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
17. Name of Bank 18. Address
BA /_ 2- 15
19. City 20. County 21. State 22. Zip Code
-Pc V.6" " NIM al
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 TR E.
23. Date 24. Signat re of Candidate
�� � � � �3 X
25. pp Treasurer's Acceptance of Appointment(fill in t e lanks and check the approp ate block)
I, �,L�SNAIMA+� , do hereby accept the appointment
(Please Print or Type Name)
,ignated above as: Campaign Treasurer. Dep Treasurer.
01 W X
ate Signatur of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev.07/23) Rule 1S-2.0001, F.A.C.
� STATEMENT OF 0FFlCWffftjD CANDIDATE NOV - 9 2023
(Section 106.023, F.S.) VILLAGE CLERKS E
(Please print or type)
1, JtSr,.
�0 �W4 ,
candidate for the office ofJ111AH ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X0
Signat a of Candidate I D to
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)