HomeMy WebLinkAboutCaruso, Mark DS-DE 9 & DS-DE 84 - 2024 07 11.pdfAPPOINTMENT OF CAMPAIGN TREASURER
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AND DESIGNATION OF CAMPAIGN
JUL 1 1 2024
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
CITY OF WINTER SPRINGS
OFFICE OF THE CITY CLERK
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the filing officer before
opening the campaign account.
OFFICE USE ONLY
1. 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 PO Box or Street, City, State, Zip Code):
(Please Print or Type Name)
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4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
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( required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
8. If a candidate for a nonpartisan office, check the box
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if applicable:
❑ I intend to run as a Write -In Candidate.
9. If a candidate for partisan office, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write -In Candidate. ❑ No Party Affiliation Candidate. ❑ Party candidate.
10. I have appointed the following person to act as my: ❑r--C'aimpaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
12. Telephone:
13. Email Address:
14. Mailing Address: 15. City.
16. State:
17. Zip Code:
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18. 1 have designated the following bank as my (check appropriate box): rimary Depository ❑ Secondary Depository
19. Name of of Bank:
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20. Address:
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21. County:
23. State:
24. Zip Code:
%City: LL12.
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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
26. Signatur f Candid
25. Date: — ( — Z �/
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
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I, do hereby accept the appointment designated above as:
(Please Print or Type Name)
Campaign Treasurer. ❑ Deputy Treasurer.
29. Signature of Ca Treasurer or Deputy Treasurer
28. Date: Z y
DS-DE 9 (Rev. 09/23) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
candidate for the office of
FICEIVEU
JL!L 1 1 1024
P-ry�% p� VVINiER SPRINGS
a�FICE OF THE CITY CLERK
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 (OS/11)