HomeMy WebLinkAboutJones- Appointment of Deputy TresurerAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
no PM 5: 30
(Section 106.021(1), F.S. )
(PLEASE PRINT OR TYPE)
RECEIVED
CITY OF TAM%IS AC
NOTE: This form must be on file with the qualifying
l?
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
0 Initial Filing of Form Re -filing to Change: 19" Treasurer/Deputy dDepository ❑ Office Parry
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
code)
1v11GN-F,;�LLE AlAI)PIEA Junk.;
FS30 ►�W (9 Nt, {kV NuE # 21i3
4. Telephone
5. E-mail address
T-A"P RAC, FL 333191
GtgAiL, Cvwi
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
C ITI C c> Nt t l t SS I O nl irl2
applicable:
DIS-w CT 1
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 0 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
M I CI E I -LE A w SEA 3 6 j� LS
11. Mailing Address
12. Telephone
'A3U Nw Ul+"� AVL1\iuL # 211v
( 154) 31,09• 3$(vi
13. City
14. County
15. State
16. Zip Code
17. E-mail address
TA NI f
13RU vQ Ik-LLj
�L
333 �i
C H)E�M tC: �+c-LLC..JDNeSC� 6-lAIC.-L6�
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank
20. Address
To 13ANI< 1
W PIAE ISLAMb oAD
21. City
TE�.County
23. State
24. Zip Code
P LA TALI 0 /,1
R bvJ A rib
t= L.
3 3 3 22,
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOI G FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THA THE FACTS STATED IN IT ARE TRUE.
25. Date
26. Si
ture of Candid
X/
._.
✓
27. Treasurer's Acceptance of Appointment (fill in the S and check the appropriate block)
I, M 101 ELLS ANbRC.A J 6Ia6 do herebythe accept p appointment
(Please Print or Type Name)
designated above as: Campaign Treasure Deputy Treasurer.
1�3�1CI X �r
Date ignature of C paign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) 41111�' Rule 1S-2.0001, F.A.C.