HomeMy WebLinkAboutJoseph M Lanouette - Designation of Campaign Treasurer - DS-DE 9APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
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 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
applicable:
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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 RI CC,,,(N Party candidate.
' have appointed the following person to act as my
Campaign Treasurer ❑ Deputy Treasurer
u. Name of Treasurer or Deputy Treasurer
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
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19. Name of Bank ��s
20. Address Y
21. City
22. County
23. State
24. Zip Code
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. SiWturfCandidate
'V�e�D v Z� �Z
X
27. Treasurer's Acceptance of Appointment (fill in the bYnks and check the appropriate block)
V\, C.(AJ1U 0Q-A C✓
do hereby accept the appointment
(Please Print or Type Name)
designated above as: FQ Campaign Treasurer.
Deputy Tre r.
Date
a re of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.