HomeMy WebLinkAboutAppointment of Treasurer_Frank D'Ambra_10/24/2017 RECEIVED
PPOINTMENT OF CAMPAIGN TREASURER OCT 2 4 2017
AND DESIGNATION OF CAMPAIGN VILLAGE CLERKS OFFICE
DEPOSITORY FOR CANDIDATES
(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
1. CHECK APPROPRIATE BOX(ES):
Eg Initial Filing of Form Re-filing to Change: ja Treasurer/Deputy )Z Depository ❑ Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address(include post office box or street, city, state, zip
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4. Tel1eph//one(( 5. E-mail ad address -� �g�� FL• � '3 L`()T
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6. Office sought(include district, circuit, 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
❑ Write-In ❑ No Party Affiliation ® Party candidate.
have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
i u. Name of Treasurer or Deputy Treasurer
11. Mailing Address 12. Telephone
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13. City 14. County 15. State 16. Zip Code 17./E-m`aiil address/� y
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
lace(_ 4- A K2t%CA., I I S D � 6- -`�0 vc.
21. City 22. County 23. State 24. Zip Code
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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 Candidate
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27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, f1*1 `� , do hereby accept the appointment
(Please Print or Type Name)
;ignated above as: Campaign Treasurer Deputy Treasurer.
to[Zy 12-60 X 7�
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.