Spencer - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign - 2-29-24APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
/RECEIVED/
(PLEASE PRINT OR TYPE)
FEB 2 91014
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)
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K�rnberlAOn SQ�►�C�r
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4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
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10 3 9:; y 5
S1 en e e90 fiFo - CCO mCCI IS; '. O cfi
(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:
❑ I intend to run as a Write -In Candidate.
9. If a candidate fora check the box and fill in the name of the party as applicable: I intend to run as a
E]Write-InCandidate. arty 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:
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(C1uN) `i 76 13-7q
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14. Mailing Address: `- /
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5. City:
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16. State:
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17. Zip Code:
3 2 L3�
18. 1 have designated the following bank as my (check appropriate box): 2"Primary Depository ❑ Secondary Depository
19. Name of Bank: i
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20. Address:
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21. City.22.
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County:
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23. State:
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24. Zip Code:
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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. Si nature of Candidate:
25. Date:
27. Treasurer's Acceptance of Appointment (fill in the blanks and rhe the appropriate box)
/^� ej
I, do hereby accept the appointment designated above as:
(PI se Print or Type Name)
@/Campaign Treasurer. ❑ Deputy Treasurer.
29. Signature of Campaign Treasurer or Deputy Treasurer
28. Date:
DS -DE 9 (Rev. 09/23) Rule 1S-2.0001, F.A.C.