HomeMy WebLinkAboutStaats - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign Depository - Dee Reiter - Campaign Treasurer 5-15-26APPOINTMENT 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.
/ RECEIVED
MAY 1 52016
04515
1:)S p`
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
0 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)
Nancy Elizabeth Staats
3. Address (include PO Box or Street, City, State, Zip Code):
2038 Beach Avenue
Atlantic Beach, FL 32233
4. Telephone:
(732 ) 687-6199
5. Candidate's Voter Registration #:
125218686
6. Email Address: Orp�
�l
1 n "�1�"I , ✓ "
®�
(not required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
Commissioner-Mayor, Seat 1, Atlantic Beach, FL
8. If a candidatefora nonpartisan office, check the box
if applicable:
❑ I intend to run as a Write-In Candidate.
9. If a candidate for maim office, check the box and fill in the
❑ Write-In Candidate. ❑ No Party Affiliation Candidate. ❑
name of the party as applicable: I intend to run as a
Party candidate.
10. I have appointed the following person to act as my: 1 Campaign
Treasurer
)891-3305
❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
Dee D. Reiterfila(904
12. Telephone:
13. Email Address:
dr@roberts-reiter.com
14. Mailing Address: SCI
1798 Seminole ®-rave
m �Vi n�
Dr'. 1
15. City:
Atlantic Beach
16.
FL
State:
Depository
State:
17. Zip Code:
32233
18. I have designated the following bank as my (check appropriate box):
❑ Secondary Depository
❑ Primary
19. Name of Bank: 20. Address:
Wells Fargo Baok)00 ;1031 Atlantic Blvd
21. City:
Atlantic Beach
22. County:
Duval
23.
FL
24. Zip Code:
32233
UNDER PENALTIES OF PERJURY, I DECLARE THAT 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.
25. Date: 6/ 5 /2/
26. Signature of Candidate:
x j x
Treasurer's Acceptance of Appointment
l Dee D. Reiter
(fill in the blanks check
i27.
- _do hereby accept the appointment
❑ Deputy Treasurer.
appropriate box)
designated above as:
(Please Print or Type Name)
i Campaign Treasurer
29. Signature of Campaign Treasurer or Deputy Treasurer
28. Date: 5(/ VA
DS-DE 9 (Rev. 09((123) Rule 1S-2.0001, F.A.C.