HomeMy WebLinkAboutKulik - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign - Michael Kulik - Deputy Treasurer 4-17-26APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(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):
❑ Initial Filing of Form ❑ Re -filing to Change:NTreasurer/Deputy ElDepository ElOffice ElParty
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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4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
(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
�(I tlAk 5,6r,"(t,if
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applicable:
❑ I intend to run as a Write -In Candidate.
9. If a candidate for gartjsan 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 Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
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12. Telephone:
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13. Email Address:
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14. Mailing Address:
5-30 7r.�
15. City-
16. State:
17. Zip ode:
18. 1 have designated the following bank as my (check appropriate box): ❑ Primary Depository ❑ Secondary Depository
19. Name of Bank:
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20. Address. p }
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21. C yt�.
22. County:
23. }State:
24. Zip Code:
UNDOER 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. Sign of Candidet6:
q �7 ("P25. Date:
V
27. Treasurer's Acceptance of Appointment (fill in the blan check the appropriate box)
Idti' (! do hereby accept the appointment designated above as:
(P ase Print or Type Name)
❑ Campaign Treasurer. Q'Deputy Treasurer.
29. Signature-ofiGr/a?npaign Treasurer or Deputy Treasurer
28. Date: 1
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DS -DE 9 (Rev. 09/23) Rule 1S -i.0001, F.A.C.
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