HomeMy WebLinkAboutKendrick, Geoff DS-DE 9I
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN REC�E'IVE�D
DEPOSITORY FOR CANDIDATES
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(Section 106.021(l),
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(PLEASE PRINT OR TYPE) 011::11:10E OF::: � I M (��l 111 C4 ERK
NOTE: This form must be on file with the qualifying
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iOFFICE USE ONLY
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ECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: [3 Treasurer/Deputy 0 Depository E] Office Ej Party
'T'Ni—000ame o f_C`111111'andidate ("ini—this order: First, Middle, Last) 3. Address (include post office box or s�rctreet, city, state, zip
code)
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4. Telephone 5. E-mail address
.......... . - ...... . .... . .................. .......................... ...
6. Office sought (include district, circuit, group number) 7. If a candidate for a no artisan office, check If
plicable:
S'T ol' o 1 F 4J ap
E] my intent is to run as a Write -In candidate.
- -- - -------------- ---- --------- . . .. ......... ... . . ............
8. If a candidate fora 2RELosan 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.
9. 1 have appointed the following person to act as my
f'Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treas7rer
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rf.-le m IN; �'MZ1"/'__'_'._._.' -....... ------ - ...
....... — — ------ - - ----- - 11. Mailing Address 12. Telephone
13. City 1,4. County 15.E State 16. Zip Code 17. E-mail address
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18. 1 have designated the following bank as my . ..... . Primary Depository Secondary Depository
. . ........... . ........ . ... ... ............ . ....... . . . . .......... . ............. - -- ---------------------- . . . . ...................................... . . .... .. .. ..........
19. Name of Bank 20. Add-2, ress
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21 . city 22. County 23. State 24. Zip Code
02 ............
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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 §igna f�')of Candidate
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27. Treasurer's Acceptance of Appointment (fill in the blan"and check the appropriate block)
do hereby accept the appointment
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(Please Print or Type Name)
designated above as: E] ............ Campaign Treasurer Deputy Treasurer.
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Ca Date mpaign Treasurer
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DS-DE 9 (Rev. 101101
Deputy Treasurer
010111—
Rule IS-2.0001,
S-MrEgf EWr IT,
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
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candidate for the office of
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RECERVIED
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C1 MY OF:41ANTER S11,143NGS
OFFICF OF I I �1:::! C) CLERK,
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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(l)(c), 106.265(l), Florida
Statutes).
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