Woods, Carolyn Deputy Treasurer Appt. Soergel 1-18-13 APPOINTMENT OF CAMPAIGN TREASURER Received
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JAN 1 8 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):
Er Initial Filing of Form Re-filing to Change: ID Treasurer/Deputy 1.3 Depository p Office Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
o��( N � l o e�t)� code) 303
4.Telephone 5. E-mail address A•-1 a� �,•L P e-cidi f t-
( 9oN ) 2'I ) 3011 woo&for vvta.zio'i j< yyirti 32233
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
riA } 2 vt L B ecx� i 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
El Write-In D No Party Affiliation [J Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
ob ∎ v∎ So CA.
ce1
11. Mailing Address 12. Telephone
3 3(0 a"\VA SA-. • 00'1 ) 24-7- ci g itt
13. City 14. County 15. State 16. Zip Code 17. E-mail address
, A-I a vt c, l23 CA1 ^D v v Mkt- 31-2.3s u�O o d s co{rvt cat c." CI mat •C oiyyl
18. I have designated the following bank as my [h Primary Depository Secondary Depository
19. Name of Bank 20.Address
\n.(e.\\S -air a 1b 31 A+( a.v h'L r (fVd •
21. City 22. County 23. State 24. Zip Code
133/1. D L: "L.. 322.53
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. Signature of andid to
�JI 1 ' , 2.01 3 X
27. Treasurer's Acceptance�f Appointment(fill in the blanks and check the appropriate block)
I,
6 \N) dP , do hereby accept the appointment
(Please Rant or Type Name)
designated above as: El Campaign Treasurer Deputy Treasurer.
Date Signature of C P ai n Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.