HomeMy WebLinkAboutCannon, Kevin DS-DE 9 & DS-DE 84 - 2022 05 25 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES RECEIVED
(Section 106.021(1), F.S.)
MAY 2 5 7.022
(PLEASE PRINT OR TYPE)
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
PLInitial 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
'I code)
4. Telephone 5. E-mail address
6. Office sought (include district, circuit, group number), 7. If a candidate for a nonpartisan office, check if
�;�;y �✓t�l✓V►�� 5/dlV�P �, �T #� applicable:
❑ My intent is to run as a Write-In candidate.
8. If a candidate for a partisan office, c eck 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
10. Name of Treasurer or Deputy Treasurer
,,IV N.NO:v
11. Mailing Address 12. Telephone
13. City 14. County 15. State 16. Zip Code 17. E-mail address
18. 1 have designated the following bank as my C Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
21. City 22. County 23 State 24. Zip Code
, V-w- Z P,;�5 <5
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 T
25. Date_ 26. Si t e of Candidate
27. Treasurer's Acceptance of Appointment (fill i 0he blanks and check the appropriate block)
I, ;V r.1/ -V do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deput aer.
X
Date ig atur Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE RECEIVED
(Section 106.023, F.S.) MAY 2 5 2022
(Please print or type) CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
candidate for the office of UV ctJ„rv��s
AT fI
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x
51
L,8ignat6re o Candidate Dat
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(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84(05/11)