HomeMy WebLinkAboutMitchell, James DS-DE 9 [SUPERSEDED]APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RECEIVIE
DEPOSITORY FOR CANDIDATES "1Q wG 2020
(Section 106.021(1), F.S.)
Sri ir!' 0 F d H1IT:
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. I 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
) 2,1
4 Telephone 5 E-mail address ��'� � d„ w
w
6. Office sought (include district group ) _.._ circuit, rou number 7, If a candidate for a nonpartisan office, check if
�' �_� applicable:
t� „' w ��� ❑ My intent is 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: My intent is to run as a
❑ Write -In No Party Affiliation ❑ ....... Party candidate.
9. 1 have appointed the following person to act as myj Campaign Treasurer ❑ Deputy Treasurer
_.....
10.. Name of Treasurer or Deputy Treasurer
1,,j C.m r l Q,t' v d V1'� t 1/12 '11
11 Mailing Address
13 City 14. County
r l� 4't " mm ��,.� �� a 011 Wdm
18. 1 have designated the following bank as my
19. Name of Bank
2 1 I Clt ,� ��� �, 22 County
15State
N.
12. Telephone
� � � 16. Zip Code 17 E-mail address
w "
Primary Depository ❑ Secondary Depository
20 Address
V V�kN'gill
' II 'iliH'
23. State
01
24. Zip Code
UNDER PENALTIES OF PEf(JURY, 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. ate
26. „ Signature of Can
didate rs
27. Treasurer's Acceptance of Appointment (fill ih the blanks and check the appropriate block)
do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑" Campaign Treasurer ❑ Deputy Treasurer.
Signature ture of Campaign T Treasurer or
Date gDeputy Treasurer
DS-DE 9 (Rev. 10110)
Rule 1S-2.0001, F.A.C.