HomeMy WebLinkAboutBenton, Matthew DS-DE9 & DS-DE 84 - 2024 07 16.pdfAPPOINTMENT OF CAMPAIGN TREASURER
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AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
AL 1 G 2024
(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 ❑ ReAling 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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W�ta.'i E12 SP'S�1NC�5 , ("L 327c5g
4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
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required for qualifying
.(not 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 Write-in Candidate,
run as a
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. 1 have appointed the following person to act as my: EfCampaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
12. Telephone.
13. Email Address:
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14. Mailing Address:
15. City:
16. State:
17. Zip Code:
5cAc( /wLTDti( P20
Ni STEP SPpaIt.3
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�270(0)
18. 1 have designated the following bank as my (check appropriate box): [D'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 THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE:
26.. Signature of Candidate:
25. Date: —t' 1 1 Zy
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
I, OCD cJN•A f3nu N o do hereby accept the appointment designated above as:
(Please Print or Type Name)
[]Campaign Treasurer. ❑ Deputy Treasurer,
29. Signature of Campaign Treasurer or Deputy Treasurer
28. Date: 1 1 13 2 L
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DS-DE 9 (Rev. 09/23) Rule 1S=2.0001, F.A.C.
STATEMENT OF
CANDIDATE
(Section 106,023, F.S.)
(Please print or type)
a � Q �vo(� �Y\rvo1�\
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).
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