Woods, Carolyn Treasurer Appt. Hite-1-14-13 APPOINTMENT OF CAMPAIGN TREASURER Received
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JAN 1 4 2013
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) Office of City Clerk
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1.CyECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository 0 Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street,city, state,zip
G/�tzc>,YKi Wool's code) 303 (� w,
4. Telephone 5. E-mail address ATLA N-C t G BC2- Fri
( ci0LI ) 2.4( I �eii3 WOODS foe I'V1a�o.- ®gMw�l ,Com 3'LZ 3
6. Office sought(include district,circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
I B-f-A-e l-h El My intent is to run as a Write-In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
❑ Write-In ❑ No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my f Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
i1 -FF ITE
11. Mailing Address 12.Telephone
\ 015 RI, ( 6101 ) to`'&
13. City 14. County 15. State 16. Zip Code 17. E-mail address
A 1 Li4til"fI L •Gk 17J:�Ati �� 32235 -7"A DAD gl A°1—
18. I have designated the following bank as my /Primary Depository ❑ Secondary Depository
19.Name of Bank 20.Address
F.-,,L1. F Gb 1031 "--rt-AJTI G laLvo ,
21. City 22. County 23. State 24.Zip Code
Tt,,4 Tit.vAL- PL- 32233
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date 26. Sig re of andidate
9013 X
27. Treasurer's Acceptance of Appointment(fill in the bla and check the appropriate block)
RN t'2,- , do hereby accept the appointment
/ (Please Print or Type Name)
designated above as: a Campaign Treasurer ❑ Deputy Treasurer.
/
/ I – 13 X A ��-
Date -I•' ure of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.