Gabrynowicz - DSDE9- Appt. Deputy Treasurer- Mark Gabrynowicz- 7-19-24APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
/ RECEIVED
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
JUL 19 1011
(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 I!a 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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M+ P �K C9ha,R_'(tJ�uJ C�
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4. Telephone: 5. Candidate's Voter Registration #:
6. Email Address:
c q04) \0k3p 103166051
for
M c ® (5�?Vt3OuJ�C� . CdM
(not required qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
8. If a candidate for a nonoartisan office, check the box
,1-W*%\MC_ g,?qC 4
if applicable:
❑ I intend to run as a Write -In Candidate.
9. If a candidate 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 �puty Treasurer
11. Name of Treasurer or Deputy Treasurer:
12. Telephone:
13. Email Address:
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(0104 ) (013 bcLo k
/"4F_&AS PL dc��c�. &
14. Mailing Address:
[0101C4��Q UACIL 11)0vn
15. City:
A7_1 C- tAOC4
16. State:
'FC—
17. Zip Code:
32Z3
18. 1 have designated the following bank as my (check appropriate box): 2Primary Depository ❑ Secondary Depository
19. Name of Bank:
20. Address:
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LIt01 PR(.4 �Jrt C_ 300 U J *I�
21. City:
22. County:
23. State:
24. Zip Code:
AT Ar kc 44Ct_�
\)44c_
Z2 -1a
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 an idate:
25. Date:
27. Treasurer's Acceptance of Appointment (fill in the blanks and the k !japp bo
l AAW1 — `&AC�Wi,�OyJkCZ do hereby accept the appointment designated above as:
(Pleasd Print or Type Name)
❑ Campaign Treasurer. 2-6eputy Treasurer.
29. Signatur of Campaign Treasurer or Deputy Treasurer
28. Date: p\ v�7
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DS -DE 9 (Rev. 09/23) Rule 1S-2.0001, F.A.C.