HomeMy WebLinkAboutStaats - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign Depository - Nancy 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 15 2126 00
r
(:) pin?
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
.11 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:
KjQi)plgifeSIYDY3 , D ,-aot
J
required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
Commissioner-Mayor, Seat 1, Atlantic Beach, FL
8. If a candida a for a nonpartisan office, check the box
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
Party Affiliation Candidate. ❑
name of the party as applicable: I intend to run as a
Party candidate.
❑ Write-In Candidate. ❑ No
10. I have appointed the following person to act as my: ❑
Campaign
12.
(732
Treasurer 0 Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
Nancy Elizabeth Staats 1
Telephone:
)687-6199
13. Email
staatsne@gmail.com
Address:
14. Mailing Address: 15. City:
2038 Beach Ave Atlantic Beach
16. State:
FL
17. Zip Code:
32233
18. I have designated the following bank as my (check appropriate box): ❑■ Primary Depository
❑ Secondary
Depository
19. Name of Bank: 120. Address:
Wells Fargo BaG 3AC-kj1 P ,1031 Atlantic Blvd
21. City: 22. County: 1 23. State:
Atlantic Beach Duval 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: 6--// 6/26,
26. Signature of Candidate:
v
27. Treasurer's Acceptance of Appointment (fill in the
Nancy Staats do
blanks
hereby
and ch
accept the
the appropriate box)
appointment designated above as:
(Please Print or Type Name)
❑ Campaign Treasurer.
0 Deputy Treasurer.
28. Date: O 6/15-- /2�
29. Sign ture of Campaign
v n' " -e-m
/`� tom
Treas rer
or Deputy Treasurer
0
DS-DE 9 (Rev. 09!23) Rule 1S-2.0001, F.A.C.