HomeMy WebLinkAboutHale, TiAnna DS-DE 9 & DS-DE 84 - 2022 03 14 APPOINTMENT OF CAMPAIGN TREASURER R E C E F
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES MAR 14 2022
(Section 105.021 (1 ), F.S.)
CITY OF W LATER SPRINGS
OFFICE OF THE CITY Ci_Frr'
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1 . ECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository Ej office D Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code) _� 4 F 4
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4. Telephone 5. E-mail address � `` •`1 •
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5. Office sought (include district, circuit, group num er) 7. If a candidate for a nonpartisan office, check if
applicable:
LV, My intent is to run as a Write-In candidate.
S. 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 Q No Party Affiliation Party candidate.
F9. 7
1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11 . Mailing Address 12. Telephone
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13. City 14. County 15. State 16. Zip Code 17. E-mail address
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18. 1 have designated the following bank as my E `f Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
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21 . City 22. County 23. State 24. Zip Code
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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 25. Signature of Candidate
1.2j.
27_ Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, 11 4 t1 IL r �44 , do hereby accept theapp ointment
p
(Please Print or Type Name)
designated above as: Roof Campaign Treasurer Deputy Treasurer.
Date Sigilature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001 , F.A.C.
OFFICE USE ONLY
STATEMENT OF I I
CANDIDATE
TAR 14"2022
(Section 106.023, F.S.)
CITY OF�\MNTER SPRILNGS
CITY print or type) OFFICE OF THE CITCLERK
IL� ze
candidate for the office of
t�
have been provided access to read and understand the requirements of
Chapter 106 , Florida Statutes.
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Signature of Candidate Date
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. 1 06. 19('I )(c), 106.265(1 ), Florida
Statutes).
DS-DE 84 (05111)