Glasser - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign - E. Glasser - Treasurer 2-1-24"I
APPOINTMENT OF CAMPAIGN TREASURER
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AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
F E B 1 2024
(Section 106.021(1), F.S.)
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(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the filing 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 PO Box or Street, City, State, Zip Code):
(Please Print or Type Name)
2 �(o tj be, G' i A v G riu cr_
IFL 322 33
4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
14 5�s Ce 0 C O C G S4-• ne
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(not required for qualifying purposes)
7.Office Sought (include district, circuit, group, or seat #):
8. If a candidate for a nonpartisan office, check the box
if applicable:
❑ 1 intend to run as a Write -In Candidate.
9. If a ca didate for partisan office, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write-in Candidate. ❑ No Party Affiliation Candidate. ❑ Party candidate.
10. 1 have appointed the following person to act as my: Campaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
12. Telephone:
13. Email Address:
14. Mailing Address:
15. City:
16. State:
17. Zip Code:
20(0 &,CJ� ����ti�
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0-k'JG I
32233
18. 1 have designated the following bank as my (check appropriate box): Primary Depository ❑ Secondary Depository
19. Name of Bank:
20. Address:
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21. City:
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22. County:
23. State:
fel,
24. Zip Code:
3 Z 23
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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
26. Signatur of Candidate:
25. Date: 2 ( I Z LA
Ix
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
I I (n l GiS do hereby accept the appointment designated above as:
(Please rintor Ty ame)
Campaign Treasurer. ❑ Deputy Treasurer.
29. Signature of Campaign Treasurer of Deputy Treasurer
28. Date: Z( 12 -LI
X C c
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DS -DE 9 (Eff. 10/23) Rule 1S-2.001, F.A.C.
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