Ford - DSDE9 - Appointment of Campaign Treasurer John McCarthy - 5-1-24APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
/ RECEIVED /
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
MAY II 12024
(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):
(Please Print or Type Name)
3. Address (include PO Box or Street, City, State, Zip Code):
3� Feac6 Ave;que.
CcG�TI S �vD
fit lc�fi� 3�ac'�� / 'r—' .32233
4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
Grille rock-in V 1 C) (-Iwai /, CCS
(not required for
qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
8. If a candidate for a nonnartisan office, check the box
I� n �� `
o
if applicable:
7 i
❑ 1 intend to run as a Write-In Candidate.
9. If a candidate for oartisan office, check the box and fill in the name of the party as applicable: I intend to run as a
dd,,,,,t,..
F-1Write-InCandidate. o 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:
! XtiA oi)t,
12. Telephone:
`�Z3--
13. Email Address:
JOGl19Mc lt) be"S"lffi� 4,21—
()_ i
(qoy) sS1
14. Mailing Address:
I U0011 Cr'eS`r04Ve
15. Cit
ros-
16. State:
F(_
17. Zip Code:
3222Zf-
IB. I have designated the following bank as my (check appropriate box): i Primary Depository ❑ Secondary Depository
19. Name of Bank:
20. Address: /
/'
�/t nJ L
1� / /
Q 0► /V-i 7✓ L /JGf+ .322 46
21. City:
��IwvsieI�I
22. C unty:
23. State
24. Zip Code:
rL
32�d6
UNDER P NALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY laTHAT TH TS STATED IN IT ARE TRUE.
26. Signa re of andi ate:
25. Date: , Zy
v /' /
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the a ropriate box)
Jahn M4 Ic
I do hereby accept the appointment designated above as:
(Please Print or Type Name)
Campaign Treasurer. ❑ Deputy Treasurer.
28. Date: 3' 1 2 0
29.Signature of Campaign Treasur of epu surer
v � f
/`
DS-DE 9 (Eff. 10/223) Rule 1$-2.001, F.A.C.
,..mss.:• - � ems .:, �.. ..v
)i
,-a- •-••aam•.n-- �r.,..._...._. ,,..m:, -.<.. .. :. .
t
► 03VI333R 1
s :.
3
Fj .. - ..
1
•�
S
f
!WVA1
..
3
�
a