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HomeMy WebLinkAboutCaruso, Mark DS-DE 9 & DS-DE 84 - 2022 07 01 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) JUL 0 1 2022 (PLEASE PRINT OR TYPE) CITY OF WNTER 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. C'VECK APPROPRIATE BOX(ES): ff 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 �I code) Cl r ham— .A ca ✓'U5 0 4. Telephone 5. E-mail address , S--�e )5j S 3 /'2— Vete- n-)a��� cap ,v'161 cc' ►� G,>i�� e r--S r��n S �r �2 71 9 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if / 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. Name of Treasurer or Deputy Treasurer hN6Lr1_- 11. Mailing Address 12. Telephone 13. City 14. County 15. State 16. Zip Code 17. E-mail address �fLr, (e,— 4� 18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository 19. Name of Bank 20.Address 21. City 22. County 23. State 24. Zip Code L_D�t ' GJ v� j �c2rn i�o �-p _r' Z 70 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) 1, (-\-(-\- C?,q r' U S-0 , do hereby accept the appointment (Please Print or Type Name) designated above as: 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 RECE,V�'® (Section 106.023, F.S.) JUL 0 12022 ( CITY OF WINTER SPRINGS Please print or type) OFFICE OF THE CITY CLERK candidate for the office of �� �/ © ►� ; have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. x� 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)