Gabrynowicz - DSDE9- Appt. Treasurer- William Grave- 7-19-24 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN ► RECEIVED
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) JUL 191074
(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): ,-,�
L1 Treasurer/De ❑ Office ❑ Party
❑ Initial Filing of Form � Re-filing to Change: puty Depository❑
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) 1°01 Std Q,(
M 1''I€ G h�2 N1.0� �c.� (c_ sA�� � X 213 3
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4. Telephone: 5.Candidate's Voter Registration #: 6. Email Address:
9to34b
toot() blts�
(notAAMLLe UA-3i2.1 01.4 . C0M
( ) (Do, required for qualifying purposes)
7. Office Sought(include district, circuit, group, or seat#): 8. If a candidate for a nonpartisan office, check the box
1A1-J T'C.- 74A(14 C4 MMkSSu L S,K 3 if applicable:
❑ I intend to run as a Write-In Candidate.
9. If a candidate for pian 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: mpaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
kA) I' i -
m Rclert - l�c r�Wr. (S 96 ) 94-16' -So - C1J.oJfi7.cc rA tc. C(i7�v+
14. Mailing Address: 15. City: 16. State. ip Code:
&luck # 20E /\-1LI PY7' C Qe(\c N EL 32233
18. I have designated the following bank as my (check appropriate box): Primary Depository ❑ Secondary Depository
19. Name of Bank: 20. Address:
ts\H( -`0C-QAL CQ D \s t1tJkot 'kb hiU-NIT\ C R-.p0 4-)fl0
21. City: 22. County: 23. State: 24. Zip Code:
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 yT ARE TRUE.
26. Signat re of can.'•ate:
25. Date: k CtV L Z X i
27. Treasurer's Acceptance of Appointment (fill in the blanks a d ch ck t • ap• opr:te bo
accept q do herebyt the :•..' designated above as:ment
I, w,��t(/1n/1 �K�Q2T1 �`�-�LvYP
(Please Print or Type Name)
Lmpaign Treasurer. ❑ Deputy Treasurer.
29. Signature of Campaign Treasurer of Deputy Treasurer
28. Date: //
6-7 I'ZcZy X tbilic i, cLeADS-DE 9(Eff. 10/2 ( II
Rule 1S-2.001,F.A.C.