HomeMy WebLinkAboutAppointment of Treasurer_Frank D'Ambra_10/12/2021 APPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES OCT 12 2021 ' 4
(Section 106.021(1), F.S.) VILLAGE CLERKS OFFKE
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CWEECK APPROPRIATE BOX(ES):
M 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
��R�v�lc, rnbCb�. , =1
code) 37-7 Co U"_ R2 _
4. Telephone 5. E-mail address C13
( J61 ) (c�ib,530`l -nkcicx.+�G comwk- ,we-t f"
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
c�b�. C&A-y k %G.�" applicable:
�`ti� �' � ' 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
❑ Write-In No Party Affiliation Party candidate.
- I have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address 12. Telephone
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13. City 14. Count 15. State 16. Zip Code 17. E-mail address
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18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank 20. Address
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21. City_ 22. County 23. State 24. Zip Code
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.
25. Date 26. Signature of Candi
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, , m. do hereby accept the appointment
(Please Print or Type Name)
;signated above as: Campaign Treasurer Deputy Treasurer.
(ab Z(
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE RECEIVED
(Section 106.023, F.S.) OCT 12 2021
(Please print or type)
VILLAGE CLERKS OFFICE
candidate for the office of lJ: �� o �fe s-I�; 064;1 1 ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
Signature of Candidate T 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(05/11)
ELECTION LAWS(State of Florida) (Chapter 99, 101, 104 & 106) 21
It is the responsibility of each candidate to read and understand all the Election Statutes and laws
http://www.leg.state.fl.us/Statutes/index.cfm?App mode=Display Index&Title Request=lX#TitlelX
CANDIDATE HANDBOOK ON CAMPAIGN FINANCING 22
https://www.teguesta.org/DocumentCenter/View/10735/Candidate-and-Campaign-Treasurer-Handbook-
Updated-10 3 2019
FAQ's- https://dos.myflorida.com/elections/contacts/frequently-asked-questions/fag-campaign-finance/
COUNTY ETHICS ORDINANCE 23
https://www.teguesta.org/DocumentCenter/View/10734/Commission on Ethics Ordinance-
effective 9-22-15
https://www.teguesta.org/DocumentCenter/View/10733/Code of Ethics Ordinance-effective 9-22-
2015
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
contents of the qualifying papers are accurate.
(Candidate Signature) Date
❑ Candidate Declined to sign acknowledging he/she received the forms.
Clerk Signature: Witness: