HomeMy WebLinkAboutDavid W Mountford - Designation of Campaign Treasurer - DS-DE 9APPOINTMENT OF CAMPAIGN TREASURER
-H%,AR,� 1_, i-.FIN `. ;., OFFICE
AND DESIGNATION OF CAMPAIGN
2022 MOR 31 PM! A
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 Form Re to Change: Treasurer/Deputy
of -filing 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)
4. Telephone r�� +
E-mail dress
71 d
+ �
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
1 ,G�
T
applicable:
My intent is to run as a Write -In candidate.
8. If a candidate fora partisan office, check block and fill in name of party as applicable: My intent is to run as a
® Write -In Ea""'No Party Affiliation ® Party candidate.
9.1 have appointed the following person to act as my 21, Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
P A Ur q
11. Mailing Address
12. Telephone
7bzo
0 5,-y o v I z
13. City
14. County
1j�1b
15. State
16. Zip Code
333,2 I
17. E-mail address
'� n� M +ss 0& � 2
18. 1 have designated the following bank as my 2 Primary Depository Secondary Depository
19. ame of Bank
20. Address
A P4 , Z> 1 ✓L�
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. Datei
26. Si nature of Candidate /
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, ,04v o-o 1_4y U tj4- (' A do hereby accept the appointment
(Please Print or Type Name)
designated above as: ��Campaign Treasurer El Deputy Treasurer.
J 3�
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.