Harding, Mitchell- Deputy Treasurer Appt. V. Harding 2-22-13APPOINTMENT 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 qualifying
officer before opening the campaign account.
Received
EEE % 2013
Office of City Clerk
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
rtEr Initial Filing of Form Re-filing to Changer Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (inthisorder: First, Mid le, Last)
i 40.k d A 6 i 1 n
3. Address (include post office box or street, city, state, zip
code) (f)3b ----1,06)/n;----1,06)/n; 0.e_ ,S4 1 r -e
4. Telephone
(%Dq)352-(>,)L1
5. mail address
g►c)a
35,1Y161ai I
+Io+i c- (41, r/ 304613
6. Office sought (include district, circuit, group numb)
7. If a candidate for a nonpartisan office, check if
0�i i' 4.. CO MM. i SS!' 0 n P, r 041-
applicable:
❑ My intent is to run as a Write-In candidate.
8. If a car didate 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
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Party candidate.
9. I have appointed the following person to act as my ❑ Campaign Treasurer ( Deputy Treasurer
7'�
10. Name ppf Treasurer or Deputy Treasur r
Liles-kW a_ r\ . kad1io
11. Mailing Address -J
(C1.35 ,y1S>"�� n2 a+r2�
12. Telephone
�%
(cQr)5q-c75'
13. City1County
Pf
(an-i`C Pak
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15. State
ri
16. Zip Code 17. E-ma I address
--;.)Q23psi l )01/03/kU1L,i)n/l/)
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18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank
sin-c,k.son /Vie g iti lL
20. Address
5 (i v A /onf,gc n, k.
21.
/lP
City
iZr ji; ,L
22. County23.
D��i�� ��
State
r--1
24. Zip Code
.3 .-6
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMP SURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE
25. Date
IdO (9°9 020/ 3
26. Signature ' Candidate
law'
I
X
27. Treasurer's Acceptance of Ap ointment (fill in he bl.; ks and c -ck the appropriate block)
I,VJO r i i Q /Y) . [ 141LXi i, do hereby accept the appo tment
(Please Print or Type )
designated above as: ❑ Campaign Treasurer Deputy Treasurer.
•
g:to_b QA,9, a 3 2 X ; �w -fi/. the
ate ignature ure of Campaign Treasurer or Deput Treasurer
9
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.