HomeMy WebLinkAboutAppointment of Treasurer_Molly Young_9/26/2024 (2) APPOINTMENT OF CAMPAIGN TREASURER Note: All information on this RECEIVED
AND DESIGNATION OF CAMPAIGN form is public information and
DEPOSITORY FOR CANDIDATES wlt.be provided to the-public. SEP 2 6 2024
(Section 106.021(1), F.S.) 2024 NOV _7 .� a; 15 VILLAGE CLERKS OFFICE
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the filing officer before
opening the campaign account. 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 PO Box or Street, City, State, Zip Code):
(Please Print or Type Name) I `r Z/
Nlb�l ��iZ � young T�ueS�a, �� 33`1�0�
4. Telephone: 5. Candidate's Voter Registration#: 6. Email Address:
I a5a 39 o�`-1 rylolt Vo (Aoa • corn
(not required for qualifying purposes)
7. Office Sought(include district, circuit, group, or seat#): 8. If a candidate for a nonpartisan office, check the box
Council Seat No.: if applicable:
(� ❑ I intend to run as a Write-In Candidate.
9. If a candidate for partisan office,check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write-In Candidate. ❑ No Party Affiliation Candidate. ❑ Party candidate.
I have appointed the following person to act as my: 2.Campaign Treasurer ❑ Deputy Treasurer
Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
f a�-A I pU-(\O) (5(.1 )3�1 U_3 S 1 S fyY ")�� �v o-� e JMcuk;
�54-
14. Mailing Address: 15. City: 16. State: 17. Zip Code:
i, �_o Zov V - uQ_s� %L 334(4
18. 1 have designated the following bank as my (check appropriate box): JZ Primary Depository ❑ Secondary Depository
19. Name of Bank: 20. Address:
tz1 VS-4-
21. City: 22. County: 23. State: 24. Zip Code:
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
26. Signature of Candidate:
25. Date: IZ�o 1 ay IX
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate box)
�0� do hereby accept the appointment designated above as:
(Please Print or Type Name)
Campaign Treasurer. ❑ Deputy Treasurer.
-7 29. Signature of Campaign T urer or Deputy Treasurer
Date: 1 (0 a� X
DS-DE 9(Rev.09/23) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
!� STATEMENT OF
CANDIDATE RECEIVED
(Section 106.023, F.S.) SEP 2 6 2024 (kt
(Please print or type) VILLAGE CLERKS OFFICE
candidate for the office of U i TegustS- a, (buj,1W S� 02.
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
Signs 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)
HANDBOOK CANDIDATE HANDBOOK ON CAMPAIGN FINANCING 23
ETHICS COUNTY ETHICS ORDINANCE 24
r https://www.teguesta.org/DocumentCenter/View/10734/Commission on Ethics Ordinance-
effective 9-22-15
Acknowledgment
I 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
contents of the qualifying paper are accurate.
(Candidate Signatuko Date
❑ Candidate declined to sign acknowledging he/she received the forms.
Clerk Signature: Witness:
Contact Information
It is important to understand your email and phone number as well as all elements of the qualifying packet are public
record.
Email you wish our office to publish: Phone number you wish our office to publish:
Ij
*As a candidate, you are required to submit Form 1 as part of your qualification paperwork. If elected, you will
need to file this form on an annual basis. However, please be advised that there is a significant possibility you
may be required to file Form 6 instead, contingent upon the resolution of ongoing state-level litigation. We
recommend that you carefully review Form 6 to determine your willingness to file this document should it
become necessary.
RECEIVED \,
5LN 3 0 2024 �`
VILLAGE CLERKS OFFICE
CAMPAIGN LOANS OFFfiefi .b
REPORT
(Section 106.075, F.S.) NOV 0 6 2024 q�1
(PLEASE TYPE) VILLAGE CLERKS OFFICE
This report applies to all candidates ELECTED to office who had loans
exceeding $500 in value, which were accepted and used for campaign
purposes within the 12 months preceding the election. All such loans
must be reported to the filing officer within 10 days after the candidate's
election to office.
0 O
Full Name f Newly Elected-Official
Office
tab 9Wt/W I
Mailing Address
' Q 9s - - 33`f eel
City State Zip Code
I CERTIFY THAT I HAVE EXAMINED THIS REPORT
AND IT IS TRUE, CORRECT AND COMPLETE.
ype or Print Name of Newly Elected Official
X
Signature
DS-DE 73(Rev.08103)