Anderson, Tim- Deputy Treasurer Appt.- 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:
X
Treasurer/Deputy 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
( )
5. E-mail address
tjacampaign@gmail.com
6. Office sought (include district, circuit, group number)
Atlantic Beach City Commission Seat 4
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 .artisan office, check block and fill in name of party as applicable: My intent is to run as a
Write -In J No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my 0 Campaign Treasurer
X Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Tim J Anderson
11. Mailing Address
824 Sherry Drive
12. Telephone
( )
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 fl 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
06/10/13
26. Signa
X
,
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Tim J. Anderson , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ra Ira•. 46'=2
06/10/13 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.
APPOINTMENT 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
Offi®a of City Clerk
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re -filing to Change:
X
Treasurer/Deputy ❑ 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
(yoy )5-1_(5)0
5. E-mail address
tjacampaign@gmail.com
6. Office sought (include district, circuit, group number)
Atlantic Beach City Commission Seat 4
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
X Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Tim J Anderson
11. Mailing Address
824 Sherry Drive
12. Telephone
(QGy )6S-1/ b) 0
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 _363
20. Address
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
06/10/13
26. Signa
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Tim J. Anderson , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer -a .,a y,k-�
06/10/13 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.