Anderson, Tim J. - Appointment of Campaign TreasurerAPPOINTMENT 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
JUN 4 2013
Office of City Clerk
OFFICE USE ONLY
1.
X
CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: Treasurer/Deputy J Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last)
Tim J. Anderson
3. Address (include post office box or street, city, state, zip
code)
824 Sherry Drive
Atlantic Beach, FL 32233
4. Telephone
(904 ) 280-8995
5. E-mail address
tjacampaign@gmail.com
6. Office sought (include district, circuit, group number)
City Commission - Seat 4
7. If a candidate for a nonpartisan 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 1J Party candidate.
9. 1 have appointed the following person to act as my X
Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Tim J. Anderson
11. Mailing Address
824 Sherry Drive
12. Telephone
( 904 ) 280-8995
13. City
Atlantic Beach
14. County
Duval
15. State
FL
16. Zip Code
32233
17. E-mail address
tjacampaign@gmail.com
18. I have designated the following bank as my
X
Primary Depository Secondary Depository
19. Name of Bank
BB&T
20. Address
363 Atlantic Blvd
21. City
Atlantic Beach
22. County
Duval
23. State
FL
24. Zip Code
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
June3,2013
26. Sign- - - • -��
X -- -'
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, M, S. A Q()o•'1 , do hereby accept the appointment
(Please
designated above as:
X
Print or Type Name)
Campaign Treasurer • • - - • • - - •
June 3, 2013 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.