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Woods, Carolyn Deputy Treasurer Appt. Woods 1-18-13 APPOINTMENT OF CAMPAIGN TREASURER Received AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES JAN 1 S 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.CHECK APPROPRIATE BOX(ES): © Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ED Party 2. Name of Candidate(in this order. First, Middle, Last) 3.Address(include post office box or street,city, state,zip C' A K O 1,`( IQ Vj U o D S code) 3(.) (n 4.Telephone 5. E-mail address A{ ( a L 1367 . , ( 9O'-1 ) 2'4I 'Vi93 Li.1oodhc' '- ,^'�a'"c, o 32- 3`3 ���a i I.C .r 6.Office sought(include district,circuit,group number) 7. if a candidate for a nonpartisan office,check if pplicable: Ni NV a,kc, r v A}-1 a`\.�0 1� -c , E 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 El Write-In ❑ No Party Affiliation ❑ Party candidate. 9. I have appointed the following person to act as my ❑ Campaign Treasurer E Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer AK.0 L-'- Iy \/MOOD S 11. Mailing Address 12.Telephone 3 0 (S21'- S ( C2(0 u )2-1 I s 9 "3 3 13. City 14.County 15. State 16.Zip Code 17. E-mail address A{ 1 av14 C B c.k L.)U 2 33 ()Jo() Yo,r wteralu vvt a i I ,c ovvi 18. I have designated the following bank as my Er. Primary Depository ❑ Secondary Depository 19. Name of Bank 20.Address s FMt( O \ l-■rJ- . 21. City 22. County 23. State 24.Zip Code AN i-1 av\h c, Q c "D v v 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. Signatu7f Ca idate av ■ k 1 ' X 27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) l Our o li-)v1 W OO ►vo , do hereby accept the appointment (Please Print or Type Name) designated above as: El Campaign Treasurer Er Deputy Treasurer. v 1 ' at) +3 X Date Signature of CIP+ I I sign Treasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.