Gabrynowicz - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign -Mark Gabrynowicz - Treasurer 4-1-24 APPOINTMENT OF CAMPAIGN TREASURER7 �VIP-7Fsq
AND DESIGNATION OF CAMPAIGN t!
DEPOSITORY FOR CANDIDATES APR - 1 2024 .1
(Section 106.021(1), F.S.)
(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):
L�'lnitial Filing of Form ❑ Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last): 3. Address (incln
u PO pox oo Strrept, C� �tate,,Zi 1Co e):
(Please Print or Type Name) CA1 yl � `
MA Z.l__ R-•�Q. -G_Afi Ca,' iC_ .;-T lc_ �W_l--\-i LL.
3X33
4. Telephone: 5. Candidate's Voter Registration#: 6. Email Address:
I qVi) LIP\ID (AC \ 1 CD '4tV06\c6 4--- M Afi‘_VYA52--00 UJiCt- . cde
(not required for qualifyingpurposes)
7. Office Sought(include district, circuit, group, or seat#): 8. If a candidate for a ponoartisan office, check the box
C c\'( �f ALF I C . .,P\Q� if applicable:
C (0,4 \c S 4
\ 2- c3 p 1 2 ❑ I intend to run as a Write-In Candidate.
9. If a candidate for eaten 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. I have appointed the following person to act as my: p Campaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
N\Pl( - (3-462- 6vJ C:,� ( TC-1) l� 13 (��1D l Mie- 6 2 j41(Ja 41/(Z14. Mailing Address: 15. City: 16. State: 17. Zip Code:
-A2_12_4 D- 14___ Niu, OT\c_ F- -If-y:\, . ()al 0 ,)\- 7 z 3
18. I have designated the following bank as my (check appropriate box): ❑ Primary Depository ❑ Secondary Depository
19. N me of Bank: 20. Address:
�\\I F4�g�� C-2A J) 14) i L0 A--i 01- 1•1-0C_ .' D 3(,�J(s2 C
21. City: 22. County: 23. State: 24. Zip Code:
AT ,L 1?;.�i -k - ) JAL \- c, e-,2_23
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. Signature o' andidate:
25. Date: '
kP/2iL.- 2024 X
27. Treasurer's Acceptance of Appointment(fill in the blanks and c : k the a'propri- - •ox),
I, IV\AQY- Gi/Y-j-p_\o)I V'V
l C- do hereby accept the appointment •- ignated above as:
(Please Print dr Type Name)
'6ampaign Treasurer. ❑ Deputy Treasurer.
29. Signature o�Ca paign Treasurer or Deputy Treasurer
28. Date:
1\pz�`t X A'I./
DS-DE 9(Rev. 09/23) l Rule 1S-2.0001, F.A.C.