HomeMy WebLinkAboutResnick, Cade DS-DE9 & DS-DE 84 - 2022 06 03 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RECEIVED
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) JUN 0 3 2022
/PLEASE PRINT OR TYPE CITY OF WINTER SPRINGS
1 ) 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):
0,- nitial 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) L''3c• l�
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4. Telephone 5. E-mail address
6. Office sought (include dist 6t, circuit, group number) 7. If a candidate for a nonpartisan office, check if
e-_`/ j. Com,- ��v�fr - �✓'"-i,��s, applicable:
❑ 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 my ® Campaign Treasurer ❑ Deputy Treasurer
10. Mmeof Treasu r or Deputy Treasurer
� hoc �
11. Mailing Addre12.Telephone
s
13. Cit County_ 15. State 16. Zip Code 17. E-mail address
FL vel ttu lo-/�� �t 1 .
18. 1 have designat the following bank as my Primary Depository ❑ Secondary Depos't ry
19. Name of Bank 20. Address
21. City 22. -ounty 23. State / 24. Zip Code
UNDER PEN/k IES 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 26. Signature of Candidate
0� c� 3 2o 12 X
27. Treasurer's Acceptan�ce�of Appointment (fill in the blanks and check the appropriate block)
1, '� (�) C' �✓L�(�/f do hereby accept the appointment
(Please Print or lye Name)
designated above as: Campaign Treasurer Deputy Treasurer.
'y0
Date Signature of Ca pai n Treasurer o uty 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.) JUN 0 3 2022
(Please print or type) CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
candidate for the office of G���;�r �- ;,?�, %�y s �o�•�wr�s s �_� ;
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. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84(05/11)