HomeMy WebLinkAboutJoseph M Lanouette - Designation of Campaign Treasurer - DS-DE 9 - AmendedAPPOINTMENT OF CAMPAIGN TREASURER
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AND DESIGNATION OF CAMPAIGN
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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 ES-) Party
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
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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 �4 No Party Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my 19 Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address
12. Telephone
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
19. Name of Bank
20. Address
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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. S' ure of Can jdidatQ
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27. Treasurer's Acceptance of Appointment (fill in Wanks and check the appropriate block)
1, L_-CVjC> L)Q-' tQ-- do hereby accept the appointment
(Please Print or Type Name)
designated above as: ® Campaign Treasurer. Deputy Treasurer.
Date Si ature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) r Rule 1S-2.0001, F.A.C.