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HomeMy WebLinkAboutJohnson, Ted DS-DE 9APPOINTMENT OF CAMPAIGN TREASURER IIFtEcr-.IVED AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES "EC 17 2019� (Section 106.021(1), F.S.) 0TY OF W,MER (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before openin the cam ai n account. OFFICE USE ONLY 1. g449CK APPROPRIATE BOX(ES): Initial Filing of Form Re -filing to Change: 0 Treasurer/Deputy N�Depository C] Office F] Party 2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip code) 4. Telephone 5. E-mail address Y67 ) 731 -0 936 ejc"A ewm 6. Office sought (include district, circuit, group number) W - _r 7-E k S J-FW 7- 7. If a candidate for a non artisan office, check if applicable: E] my intent is to run as a Write-in candidate. 8. If a candidate for a Rartisan office, check block and fill in name of party as applicable: My intent is to run as a F1 Write-in E] No Party Affiliation [] . . . ..................... candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer E] Deputy Treasurer 10. Name of Treasurermmmmmor Deputy Treasurer -7-2rlp -D fivi:� --re ff A)z O"o 11. Mailing Address //0,7 0j1ArjStj..-v7- e1WCL-i5- 13. City 14. County 15. State V--rm'rrg SPe ri1G5 _<EA-7.rIV Ft- 18. 1 have designated the following bank as my e ..... . . ................ . . - - — -- ­, - 19. Name of Bank 21. City '?2. County 0 Vx g, -b e� e L r 12. Telephone 3 2- 70K (qo?) j7,??-0y34 16. Zip C 32.©..�.... ��Dhn m�.............gers.r''^.t..e.....r.A -7 I Primary Depository ❑ Secondary Depository 20. Address 1 23. State 24. Zip Code 32 76S` 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 27 4Z / / 7 26. Signature of Candidate . ........ . X fY­­ ­­­) Treasurer's Acceptance of Appointment (fill in the blanks and check ttte appropriate block) do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer El Deputy Treasurer. ----- - - - ------- il,ht-e - ------ I ------------------------------ ------- --------------- -s-i-griature of Campaign Treasp 11 rer Deputy Treasurer DS-DE 9 (Rev. 10110) Rule IS-2.0001, F.A.C.