HomeMy WebLinkAboutAppointment of Treasurer_Aaron Johnson_11/10/2021 PPOINTMENT OF CAMPAIGN TREASURER DECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 0 2021
(Section 106.021(1), F.S.)
PILLAGE CLERKS OFFICE
(PLEASE PRINT OR TYPE) 7
NOTE: This form must be on file with the qualifying
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 post office box or street, city, state, zip
code) ( 1Mf� AN SV6�D
4. Telephone 5. E-mail address 1
(154 ) 0 P,wr�nvo jar
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
�e_
(�, applicable:
�l w*1r\6` v t�`(-YA ❑ My intent is to run as a Write-In candidate.
8. If a candidate fora artisan office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write-In ❑ No Parry Affiliation ❑ Party candidate.
have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasur r or Deputy Treasurer
1'�`COV\ ��h�sa�,
11. Mailing Address • ( 12. Telephone
13. City 14. County 15. State 16. Zip Code 17. E-m it address
hsov� �a l�.CA
18. 1 have designated the following bank as my [ Primary Depository ❑ Secondary Depository
Bank 20.
19. Name of � 45dress
21. Ci(y 2� County � 23.�to �. Zip Cod
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. Sig at of Candi to
27. Treas rer's Acceptance of Appointment (fill in the blanks and the he appropriate block)
I, ��T�rav--) , do hereby accept the appointment
(Please Print or Type Name)
.ignated above as: Campaign Treasurer ❑ Deputy Treasurer.
k\�_ k 0 - q/�*'I X Qi� A-��
Date Signature of m aign 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.) NOV 1 n Zn% <ilr-
(Please print or type) VILLAGE CLERKS OFFICE
"0 V)
candidate for the office of \\XWU Q J C
;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
I
X
Signatu o 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)