HomeMy WebLinkAboutJames Evans DS DE 9 - New Bank1 (2019 11 06)Q� ro mmmu 11 Oil 51�111. 111A
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 oDenina the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re -filing to Change: E] 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
r— code)
le jt '5, 21�
. . . ..........
4. Telephone 5. E-mail address
17C
I
.... ........ ... .... .... . . . ..... . ........
6it, group number) 6. Office sought (include district, circ 7. If a candidate for a nonpartisan office, check if
c r) applicable:
tA)l 4-� 1s; A 5 1:_,� �_
- C r 4, r.) V'') t", Ej My intents to run as a Write -In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable:
n Write-in 0 No Party Affiliation . ................ . ....... __
9. 1 have appointed the following person to act as my
10. Name of Treasurer or Deputy Treasurer
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) 0 ry, k"C's
11. Mailing Address
rn
F1 Campaign Treasurer
13. City 14. County 15. State
FL,
18. 1 have designated the following bank as my
19. Name of Bank
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V
21. City
0 ,,
o
22. County
S le " I cl
.......... .......................................................................... . ..........
My intent is to run as a
Party candidate.
Deputy Treasurer
12. Telephone
.......... I , ( ) .... ...... .............
16. Zip Code 17. E-mail address
[:] Primary Depository
20. Address
a
( 0 (91 401
23. State
[] Secondary Depository
24. Zip Code J, �"',
7(
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
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, 5111 do hereby accept the appointment
. ...... . ............... _-L . . ..........................
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer
I � , ( / ( I
...... . ...... -------------------- - . ........... -
Date
Deputy Treasurer.
nature of Campaign Treasurer or Deputy Treasurer
Rule 1S-2.0001, F.A.C.
DS-DE 9 (Rev. 10/10)