HomeMy WebLinkAboutMcCann, Kevin DS-DE 9 & DS-DE 84 - 2022 06 02 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES RECE1VIE®
(Section 106.021(1), F.S.)
JUN 0 21021
(PLEASE PRINT OR TYPE)
CITY OF WNTER SPRINGS
NOTE: This form must be on file with the qualifying OFFICE OF THE CITY CLERK
officer before opening the campaign account. OFFICE USE ONLY
P1. 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)
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4. Telephone 5. E-mail address
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6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
11914applicable:
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❑ 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. Name of Treasurer or Deputy Treasurer
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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 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 26. Signature of Candidate
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
f�• a, m < do hereby accept the appointment
(Please Print or Type Name)
designated above as: ja Campaign Treasurer ❑ Deputy Treasurer.
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE `�' w
(Section 106.023, F.S.) JUN 0 21022
GS
(Please print or type) OFFICE OF THE CITY CITY OF TERILE RK
candidate for the office of ,4MVe Gzry
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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)