HomeMy WebLinkAboutEvans, James DS-DE 9 (2019 10 31)pi„ vauaNw
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APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
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):
Initial Filing of Form Re -filing to Change: 0, 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
James Melvyn Evans code) .
Y 217 Almaden Ct, Winter Springs, FL, 32708
4. Telephone 5.
- ail address
6407 0ffice sought 48clude d'strlct,
1 umber)
Winter Springs City Commissioner District 1
7. If a candidate for a non artisan office, check if
applicable:
My intent is to run as a Write -In candidate.
8. If a candidate for a p#ft1saIj office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write -In ® No Party Affiliation
9.1 have appointed the following person to act as my
10. Name of Treasurer or
Deputy
Treasurer
Helen Markward
11�. Mailing Address..mm�..........�...,.�_�...........�.�.�..................
217 Almaden Ct
13. City 1 14. County
Winter Springs Seminole
18. I have designated the following bank as my
19. Name of Bank
Fairwinds Credit Union
Count
Winter Springs .... .._._ .._. _ Se � County
21. Clty 22.
Seminole
m Campaign Treasurer ❑
15. State 16. Zip Code
FL 32708
Party candidate.
Deputy Treasurer
12. Telephone
( 407 ) 3995403
17. E-mail address
markward.h.r@gmail.com
® Primary Depository ❑ Secondary Depository
20 Address _..� .............. — ......,
1475 Tuskawilla Rd
23. State 24. Zip Code
II FL 32708 m
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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
27.
•
Treasurer's Acceptance Appointment
(Please Print or Type Name)
designated above as: 7p�, Campaign Treasurer
_ ..
1 ___. W _ m .....
_._ .... Date
26. Signatufp)of Candidate
the blanks and check the appropriate block)
, do hereby accept the appointment
Deputy
of ('ampaign Treasurer or Deputy Treasurer
Rule 1S-2.0001, F.A.C.
DS-DE 9 (Rev.10110)
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
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 camoaictn 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) 217 j'jrV1qjjpt1 C-t
Ja e5 (V1e 1 v ✓ s I.c.1,`tj4-e-r s p r0?
4. Telephone E ;rya_ II address
yo l I I FeA Co wt M iss' i e K r
TAwW$ ._ . .- ti-..--- ...........
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
;,A -f -e.� S Q t '1S Go m M I S S• C) applicable:
My intent is to run as a Write -In candidate.
8. If a candidate fora partisa,n office, check block and fill in name of party as applicable: My intent is to run as a
U Write -In C3 No Party Affiliation ®wWm _ w„ Party candidate.
9. 1 have appointed the following person to act as my ❑ Campaign Treasurer Deputy Treasurer
.......... . ..... ._. ........
10. Name of Treas9VA
r or Deputy Treasurer
J o, me,s r1.S
__ .. ......................_..___.._............ ..__W... ... ._..m.. ....... .............
11. Mailing Address 12. Telephone
211 0)mAJen C4- W11,14-er SP(;45 s f: L 32-7og (col ) L1!)2 -13 LIQ
_..__.. _W ..... ...... ...... ...................
13. City 14. County 15. State 16. Zip Code 17.
--a�address
�P �,frus Sem i no !e FL. 3-z. 7 o 8 e c M �,.rs ;oG Q
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
_. ...... ....... .m.�.........
..........._,.._.._.. _
19. Name of Bank 20. Address
Ceea;4- U ,o HIS TVS1<QW1110I
21. City 22. County 23. State 24. Zip Code
c..�J; A+ec S,p f; n.9 s Senn +Hole 1`�
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
RD
27. \ Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, .) a Y"?IS Ey a� S , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer Deputy Treasurer.
Date ..s' i3ignature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
candidate for the office of Wint11 ,� ingsITCommissioner District 1
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
P
Signature of Candidate
Dz e
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)