HomeMy WebLinkAboutMitchell, James DS-DE 9 - New Bank and Treasurer - 2020 08 28APPOINTMENT OF CAMPAIGN TREASURER
R E C
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES AUG 1,2 2010
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) C)F: F [CE 7'f If C,[T'Y C� I EFR <
NOTE: This form must be on file with the qualifying
officer before opening the cam l),aign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re -filing to Change: Treasurer/Deputy Depository ❑ Office E] Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code) 102, )4
7 3
4. Telephone E-mail address 07
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6. Office sou ght"(include istril', circuit, group nu b�g
er) 7. If a candidate for a ngnpArtlsan office, check if
AA 1V applicable:
❑
My intent is to run as a Write-in candidate.
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8. If a candidate for a partisan office, ct4ck 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 Campaign Treasurer ❑ Deputy Treasurer
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10. Nam of Treasurer or Deputy Tre surer
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11. Mailing Add ess 12. Telephone
13. City 141. County ito ... i'E.—iip"Cod *1 dd
7" � 17 E-mai a r
41, 1
jl�7 e,�j P) All
18.1 have designated the following bank as my Primary Depository ❑ Secondary Depository
. . .................. ....... 111.d - ----- . . . . . . . . . . ........................... . ........
19. Name of Bank 20. Address
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21. City 22.,,County 23, State 24. Zip Code
166 el V ro) ,,o/ elf ode!�
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.
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25. Date 26. Sign�aure of Candidate
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27, Treasurer's Acceptance of Appointment (fill°tri the blanks and check the appropriate block)
1, i't A� do hereby accept the appointment . .. . ........
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
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Date
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__7 -----Campaign Treasurer or Deputy Treasurer
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DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.