Hill, James- Deputy Treasurer Appt. 3-4-13APPOINTMENT 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
MAR - 4 2013
Office of City Clerk
OFFICE USE ONLY
1. C/RBCK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
,TGC V" eS Ke t t y ki l l
3. Address (include post office box or street, city, state, zip
code) 37 z -14-k Stre e_+-
. -4
A-j-{ )A-1-i C BCa.C.,(•t R. 3aL33
4Telephone oet7
2 f 62 1543
5. E-mail address
. -fi1i tv1 e 1 "rya koo C c-vr)
6. Office sought (include district, circuit, group number)
ec.) fv1,r✓1 I SS t o v-Ie{-_ Sea* y
7. If a candidate for a non 'artisan office, check if
applicable:
❑ 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 ❑ Campaign Treasurer 1:73- Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Jo AeS K \-k \\
11. Mailing Address
312- -1Skv'ese_i-
12. Telephone
(qou ) ZL-1Co-1Sy
13. City
Art-\o c &ad/
14. County
Ju v o\ \
15. State
Fi,
16. Zip Code
3?z_.33
17. E-mail address
b ±Mi e e i.e-koO .corm
18. I have designated the following bank as my Ly' Primary Depository ❑ Secondary Depository
19. Name of Bank
.\0 r,S
20. Address
(\arc vk-ree__-\-1Q ne. [6:(.6)
21. City
N e_Ao-f-v.n e eep e ooc
22. County
FL-
23. State
3223 3
24. Zip Code
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.
i
25 uat:
26. Sig .: re of C •i �—
x_�7
a a •� e of Ap . • int 11 en t sar the blanks an heck the appropriate block)
,Treasu �'
tfV? /L
I �J i do hereby accept the appointment
(Please Print or Type Name)
de ' • . ed above as: ❑ Campaign Treasurer Ilf<eputy T .-,, '.-
/ /`'�
Date ignature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.