Appointment of Treasurer_Luila Cheverez_9/20/2023 APPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN SEP 2 0 2023
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) VILLAGE CLERKS OFFICE
(PLEASE PRINT OR TYPE) 9.,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):
ZInitial 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)
,L. To kioe- C,heve_rez
' 02 1vi
4. Telephone 5. Candidate's Voter Registration#: J
(Not required for Qualifying Purposes) ups F� 33Y�q
(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):
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
f CIO`� le�I applicable:
I I I(,LC� vt T�q(,(t�ST�L-� vI iQ9R 1 My intent is to run as a Write-In candidate.
ill
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.
j. I have appointed the following person to act as my �' Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer 11. Telephone
LuU l a_ ,TpS h ne. 0heV-ere_Z_ ( &/ ) :3 - 7y&&,
12. Mailing Address 13. City 14. State 15. Zip Code
/ -.� V;//a e ei,,d *-/ � Teel ues� -- 73 3,V&9
16. 1 have designated the following bank as my Fr Primary Depository ❑ Secondary Depository
17. Name of Bank J18. Address
/ /) k 9 I5 (/_) -- 1
19. City 20. ounty 21. State 22. Zip Code
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1i1') /�3(�L3/'./L L
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 Candidate )
7
25. I Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, L(,(,I l ��s� hi,��- VP/�P Z— do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0' Campaign Treasurer. ❑ Deputy Treasure
Date Signature of Campaign Treasurer or Deputy T rer
DS-DE 9(Rev.07/23) Rule 1S-2.0001, F.A.C.
RECEIVED
A iPRDINTNiENT OF CAMP14IGN TREASURER j ` 3 ^ r^
' ACID DESIGNATION OF CAMPAIGN � )`I L ��• � LQ
DEPOSITORY FOR CANDIDATES j VILLAGE CLERKS OFFICE
(Section 106.021(1), F.S.) 1
I !
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying officedr
before openingthe campaign account OFFICE USE ONLY
1,CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form WRe-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,
�.
j zip code)� lq NoseVhi17e C h e✓er-ez
4. Telephone 5. Candidate's Voter Registration#:
/5 I//Ila9 e //von
( 50 ) .5.)— /fro 1'05QOD �'
7266 (Not required for Qualifljing Purposes) /e CLe-5
(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):
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
!r/�Qgd c� e fUas7�t ��i��Q C'Ou�U� applicable:
J Sew �n� 4 ❑ My intent is to run as a Write-In candidate.
a-candidate for a partisan office,check block and fill in name of party as applicable: My intent is to run as a
write-ln ❑ No Party Affiliation ❑ Party candidate.
9. l have appointed the following person to act as my [' Campaign Treasurer ❑ Deputy Treasurer �
J
10. Name of Treasurer or Deputy Treasurer 11. Telephone
12. Mailing Address 13.City 14. State 15.Zip Code
/5 ViilLJ--je- 7'e� ��e�rLci- FL 33
16. d hav designated the following rank as my Primary Depository ❑ Secondary Depository
i
17. game of Bank 18.Address
19. City 20. County 21. State_ 22.Zip Code
-Fe Ices �ea�G�
UoIDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOIAIG FORM FOR APPOINTMEMT OF CAhIPAIG.tiI TREASURER
AND DESIGNATION OF CAiMPAIGV DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
23. Date 24. Signature Candidate
25. Treasurer's Acceptance of,Aopo ntv�ent(fill in the blanks and check the appropriate block)
e-v-,-)!� z
do hereby accept the appointment
(Please Print or Type Name)
,ignated abode as: Campaign Treasurer. ❑ Deputy Treasurer.
ELECTION CODE (State of Florida) 22
It is the responsibility of each candidate to read and understand all the Election Statutes and laws
tt www.le .state.f1,us Statutes i n clex.cf m?App mode=Displav Index&Title Re uest=lX#TitlelX
..ANDIDATE HANDBOOK ON CAMPAIGN FINANCING 23
Not available yet
COUNTY ETHICS ORDINANCE 24
https://www.teguesta.ora/DocumentCenter/View/10734/Commission on Ethics Ordinance-
effective 9-22-15
1 acknowledge that I have received all the forms and documents referenced on the "Candidate Forms List" 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
conten -of the qualifying rers are accurate.
(Candierate Signature) r-J Date
C
71
Candidate Declined to sign acknowledging he/she received the forms.
clerk Signature: Witness:
RECEIVED
SEP 2 0 2023
VILLAGE CLERKS OFFICE"VK
Ct M-Q -Cony
J
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
RECEIVED
(Section 106.023, F.S.)
SEP 2 0 2023
(Please print or type)
VILLAGE CLERKS OFFICE
a
z
candidate for the office of �+ page d Tf 9 ups- V i e 0( lw/i U;�
S 64 Gne
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
Signature of Candidat 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).
n.
DS-DE 84(05111)