Appointment of Treasurer_Laurie Brandon_9/7/2023 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES RECEIVED
(Section 106.021(1), F.S.) SEP - r' 2023
(PLEASE PRINT OR TYPE) VILLAGE CLERKS OFFU
NOTE: This form must be on file with the qualifying officer
before opening the campaign account. OFFICE USE ONLY
1.CHECK APPROPRIATE BOX(ES):
E�`lnitial 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 code)
LqjA vi C I i Za 6c4& &I A j, I 5 C� I�,Ji-�,w Ori v2
4. Telephone 5. Candidate's Voter Registration#:
(541 )_�071C/,.;2Lj 1l--2 fO'yq_/730
(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):
(.J 2- " eL-5 6ICAAJ - puti
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
Vi<<a o� TectvcSf� applicable:
Se opt 3 ❑ 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
J Write-In E No Party Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my RQ Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer 11. Telephone
Lcv<vi e (_<6 ( ) 7o-7 1
12. Mailing Address 13. City 14. State 15. Zip Code
S &d 1 6,j Z4AJ Q ({c,Lj-e _P ( 33LI& 01
16. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
17. Name of Bank 18.Address
610-r uV1 66iA )315 uJ J rf-v 31
19, City 20. County 21. State 22.Zip Code
J Lyi-1 cs a ack 33L C& q
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.
23. Date 24. Signature of ndidate
q �3 X =� A�
25. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, LaLLVN e b-2l_Undc/) do hereby accept the appointment
(Please Print or Type Name)
.ignated above as: ErCampaign Treasurer. ❑ Dep Treasure .
A?- X f
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev.07123) Rule 1S-2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RECEIVED
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) NOV 2 0 2023
(PLEASE PRINT OR TYPE) MLLAGECLERKSOFFICE
NOTE: This form must be on file with the qualifying officer
before opening the campaign account. I 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 code)
4. Telephone 5. Candidate's Voter Registration #: fi ' / 33�&L,
c t�C 5�-�
(s4i )�� i�ay ila����3�
(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):
Lo(Z- 6� 624Iv - QLA AJ
6. Office sought include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
Tc'q L,-C STD 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 VNo Party Affiliation El 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
e &izli A cz4 (5c' ) IC7
12. Mailing Address 13. City 14. State 15. Zip Code
16. 1 have designated the following bank as my E —1 Primary Depository ❑ Secondary Depository
17. Name of Bank 18. Address
,q 15 Lk<,
19. City 20. County 21. State r
2. Zip Code
�
ue,; GE ICJ F >> (DC
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.
42
23. Date 24. Signature of C ndidate
1gol"R I �
25. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, Lau V11 *` 6VCAA CL/I do hereby accept the appointment
(Please Print or Type Name)
designated above as: 'Campaign Treasurer. ❑ Depu Treasure ._
Date Signature of Campaign Treasurer or Deputy easurer
DS-DE 9(Rev. 07/23) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE RECEIVED
(Section 106.023, F.S.) SEP - l 2023
(Please print or type) VILLAGE CLERKS OFFICE
a LA-V e lam( Gtn A 0n ,
candidate for the office of y�llaa►e o� ic�✓s3�� e�►fi 3
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X q
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)