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HomeMy WebLinkAboutStaats - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign Depository - Peter Staats - Deputy 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 4 MAY 1 5 2016 OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party • Initial Filing of Form ❑ Re-filing 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: 1/\I Q II CJ © A-6 s'fYD n_' (not required for qualifying purposes) 7. Office Sought (include district, circuit, group, or seat #): 1 8. If a candidate for a nonpartisan office, check the box if applicable: Commissioner-Mayor, Seat 1, Atlantic Beach, FL ❑ I intend to run as a Write-In Candidate. 9. If a candidate for partisan 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: ❑ Campaign Treasurer 0 Deputy Treasurer 11. Name of Treasurer or Deputy Treasurer: Peter Staats 12. Telephone: (732 )687-0351 13. Email Address: peterstaats@hotmail.com 14. Mailing Address: 2038 Beach Ave 15. City: Atlantic Beach 16. State: FL Depository 17. Zip Code: 32233 18. I have designated the following bank as my (check appropriate box): UJ Primary ❑ Secondary Depository 19. Name of Bank:20. Wells Fargo Beek ggL )J nl Address: 1031 Atlantic Blvd 21. City: Atlantic Beach 22. County: Duval 23. State: FL 24. Zip Code: 32233 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. 25. Date: 16/24, 26. Signatu a of Candidate: v n /' l�LJ 27. Treasurer's Acceptance of Appointment (fill in the blanks Peter Staats do hereby and chec a appropriate box) accept the appointment designated above as: U Deputy Treasurer. (Please Print or Type Name) ❑ Campaign Treasurer. 28. Date:_- K52, 02 29. Signaturedf Campaign T."-- ur- >' IIIME • r Deptut~y�Treasurer DS-DE 9 (Rev. 09/23) Rule 1S-2.0001, F.A.C.