Anderson, Tim- Treasurer Appt.- Change 6-11-13APPOINTMENT 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
JUN 1 1 2013
Office of City Clerk
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re-filing to Change: a Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
I/VI �. �n(SCI j
3. Address (include post office box o treet, city, state, zip
code) i �y
iie
, Ao4k 3etz&L( R. '3 3
4. Telephone
(101) ix(- -aa
5. E-mail address
-�j \C.A9 A(5 ?9mKtI, coM
6. Office sought (include district, circuit, group number)
foevoisEiolsw�,
7. If a candidate for a non s artisan office, check if
applicable:fetfritvoLgeokAcv
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 0 Party candidate.
9. I have appointed the following person to act as my pi Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
13EAu aAkER
11. Mailing Address
riga Sea 004eS Or.
12. Telephone
('10 ) 7% - 736/
13.
City14.
rI13
County15.
pt4v�
State
FI
16. Zip Code
3?33
17. E-mail address
bbakerIoak) @ yettib .cam,
18. I have designated the following bank as my 2 Primary Depository ❑ Secondary Depository
19. Na of Bank
0Qa '1"
20. Address
363 4}-I
-rz atwel
21. Qity
#1.4-it t
22. County
NOV,
23. State
FL-
24. Zip Code
2 ga 3 3
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 /� hO/9013
26. Signature of Candid t
oX
27. Treasurer's
I, EJ
Acceptance of Appointment
A MO
(fill in the blanks and check the appropriate block)
, do hereby accept the appointment
designated 1
6216\
(Please Print or Type Name)
bove as: Eic Campaign Treasurer ❑ Deputy Treasurer.
al 3 X "V---c—
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.