HomeMy WebLinkAboutAppointment of Treasurer_Laurie Brandon_9/6/2017 RECEIVED
PPOINTMENT OF CAMPAIGN TREASURER SEP / 6 2017
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES VILLAGE CLERKS OFFICE
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
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HECK 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)
La -Ie 25) ( Cf ✓
4. Telephone 5. E-mail address I eC�ueSi 3�Jc/��'J
)747-ly9y Le1voa jesC.) ao.co/L1
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
Spa( 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
n Write-In S No Party Affiliation Party candidate.
1 have appointed the following person to act as my Nr Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address 12. Telephone
1 Q ` v ( ) 707 / a
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 Seco ry Depository
19. Name of Bank 20.Address
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 C didate
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27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
1, aLA-✓'1 < 4-7 n/I Jan do hereby accept the appointment
(Please Print or Type Name)
�signated above as: Campaign Treasurer Depu Treasurer.
a 9 /1-7- X Z
Date Signature of Campaign Treasurer or eputy Tr surer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.