HomeMy WebLinkAboutMeyer, Karen DS-DE 9 - 2024 08 20.pdfAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
RECEIVED
(Section 106.021(1), F.S.)
AUG 2 1014
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the filing officer before
CITY of wNTER SPRINGS
oFFIcE of TtiE CITY CLERK
opening the campaign account.
OFFICE USE ONLY
I. CHECK APPROPRIATE BOX(ES):
12 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)
A*MrAl }A /V NCX�E,� 7111 ANWVeg el,��
Wile S'PINIVGS , oll 3 a 7eW
4. Telephone: 5. Candidate's Voter Registration #: 6. Email Address:
MP
not required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #): 8. If a candidate for a nonpartisan office, check the box
V11017 /� St?-R/N&s 4!: 0/0 �j e SS 1'9A00 � s'�T 3 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. 1 have appointed the following person to act as my: ® Campaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
KAREN ANAL MF-Y)�5R NN
14. Mailing Address: 15. City: 16. State: 17. Zip Code:
7yri �ND� r/ G/2�L wivrn Sl',Q/NGs f=L :3 a 7D 8'
18. 1 have designated the following bank as my (check appropriate box): Primary Depository ❑ Secondary Depository
19. Name of Bank: 20. Address:
TV MORG74/v LIIASj jbj3NK N. /f. %�lD ,G • Sy�J� 1�br�,U �f 3 �
21. City: 22. County, 23. State: 24. Zip Code:
U/rNT�I2 S 1�,2r�v6s S5Mi�514�5
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: ® F —� - 140d
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
1 f� �/ �
do hereby accept the appointment designated above as:
(Please Print or Typd Name)
Campaign Treasurer. ❑ Deputy Treasurer.
29. Signature of Campaign Treasurer or Deputy Treasurer
28. Date:
DS-DE 9 (Rev. 09/23) Rule 1S=2.0001. F.A.C.