HomeMy WebLinkAboutAlexandra Alvarez - Designation of Campaign Treasurer - DS-DE 9APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
T WNF'Ht; CITY CLERK ± IFFIi
(Section 106.021(1), F.S.)
2022 . UN 1.3 G'H422
(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
(4 1,21r l L
code)
4. Telephone
5. E-mail address
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
C O rym py-, SSI a ►-� e t7� S �-�' 2-
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 ❑ No Party Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address
12. Telephone
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13. City
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14. County
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15. State
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16. Zip Code
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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
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20. Address
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21. City
22. County
23. State
24. Zip ode
UNDER PENALLTIE 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. Signature of Candidate
cur
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Cu�
I, do hereby accept the appointment
(Please Print or Type Name)
designated above as: Q/ Campaign Treasurer ❑ Deputy Treasurer.
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Date Signature of Campaign Treasurer or Deputy Treasurer
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DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.