HomeMy WebLinkAboutAppointment of Treasurer_Rick Sartory_9/23/2025 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION 9F CAMPAIGN RECEIVED
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) SUS` 2 3 2015
(PLEASE PRINT OR TYPE) VILLAGE CIERKS SCE
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 ❑ Parry
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)
RIc�► tt �A f TDR" SlS �. C?o�LR �0A1
vQ N
Tl (&1A4, A f �L 33LlbCt
4. Telephone: 5. Candidate's Voter Registration#: 6. Email Address:
2q(0a 1IZ23()kS(v SA-Ai 4-V OT /� (� ►�► ct, I . � ��
(not required for qualifying purposes) C J
7. Office Sought(include district, circuit, group, or seat#): S. If a candidate for a nonpartisan office, check the box
� I L(,►�}y�L �� �vt1G� $�� if applicable:
❑ I intend to run as a Write-In Candidate.
9. If a candidate for partjn 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.
II have appointed the following person to act as my: XCarnpaign Treasurer ❑ Deputy Treasurer
Name of Treasurer or Deputy Treasurer: 12.Telephone: 13. Email Address:
14. Mailing Address: 15. City: 16. State: 17. Zip Code:
SI L N • 000� /Z Tip(A.ST rL 3 3 `l(p`y
18. 1 have designated the following bank as my (check appropriate box): ;4 Primary Depository ❑ Secondary Depository
19. Name of Bank: 20. Address:
T*D z�� sdott vt.1 Hwy 2
21. City: 22. County: 23. State: 24. Zip Code:
11 4 K'�5�t4, FA IIA, J�`z 4C �I FL 3•71 Yb
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 A THAT THE FACTS ST D IN IT ARE TRUE.
26. Signatur of 7ate
25. Date: c7� Z3 /� v
27. Treasurer's( Acceptance of Appointment(fill in the bla s and�ejthe box)
L " � ' V ! ' do hereby accept the appointment designated above as:
(Please Print or Type Name)
Campaign Treasurer. ❑ Deputy T ur r.
29. Signature ofrr
g Treasurer or Deputy Treasurer
�(� pj28. Date: 2 Ix
DS-DE 9(Rev.09/23) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF RECEIVED
CANDIDATE 2 3 2025
(Section 106.023, F.S.) VILLAGE CLERKS OFFICE
(Please print or type)
1, '�-O, j
UILt.AC� 6f Ti&(A ,SiA �oiN(-i'(- 5�4
candidate for the office of �
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X rb 2,�
Si atu f Candidate I 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)