HomeMy WebLinkAboutAppointment of Treasurer_Laurie Brandon_9/28/2021 RECEIVED
PPOINTMENT OF CAMPAIGN TREASURER
F'_il 4 02021
AND DESIGNATION OF CAMPAIGN VILLAGE CLERKS OFFICE
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) ��" C�
(PLEASE PRINT OR TYPE)
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 p�I C-0ostt office box or street, city, state, zip
LQLn code) S
ut c !7 Gt
4. Telephone 5. E-mail address � / TR 23Lf6 q
(56 1 )707 )Y I a v J
6. Office sought(include district, circ it, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
❑ 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
Q Write-In 9-'_'No Parry Affiliation Party candidate.
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
S I .mow Te u F 3 G ( 5�d �o1' Iy2y
13. City 14. County 15. State 16. Zip Code 17. E-mail address
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18. 1 have designated the following bank as my Primary Depository ❑ Se ndary Depository
19. Name of Bank 20. Address
e � 1315
21. City 22. County 23. State 24. Zip Code
3
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 C idate
� 8�l��- X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, L au yl e E2V-21)06/1 do hereby accept the appointment
(Please Print or Type Name)
signated above as: �ampaign Treasurer ❑ DepuATre ' r.
X
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 RECEIVED
CANDIDATE � � 1
(Section 106.023, F.S.)
(Please print or type)
VILLAGE CLERKS OFFICE
candidate for the office of
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X �
Signature of 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)
ELECTION LAWS(State of Florida) (Chapter 99, 101, 104& 106) 21
�*is the responsibility of each candidate to read and understand all the Election Statutes and laws
p. vvww.ieg.state.f' us;Statutes�'index.cfm?App mode= ,spia� index&-t.e ?eguest=:x itie X
CANDIDATE HANDBOOK ON CAMPAIGN FINANCING 22
nags://www.teguesta.org;Docu men tCenrer/View/10735/Candidate-and-Campaign-Treasurer-Hand boo k-
vpdated-10 3 2019
FA(Xs- https.//dos.myflorida.com/electionsicontacts;freguentiv-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:y'/ww,,v.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 quali ing papers are accurate. /
G� I
(Candidate Signature) Date
❑ Candidate Declined to sign acknowledging he/she received the forms.
Clerk Signature: Witness: