Woods- Campaign Treasurer Appt.- Carolyn Woods 1-9-15 Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN JAN 9 2015
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
Office of City Clerk
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. _ OFFICE USE ONLY
1. CHECK 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) 3. Address (include post office box or street, city, state, zip
Woods
code)
Ga -01c g • WlOoc $ SktreC�'
3O3 Cep
4. Telephone 5. E-mail address
( °1d�1 ) 2 -11• Sq GuJoo&®COalo•US
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
{ ,.. tlavv c, applicable:
r�3�o � � lj�P� (" ❑ 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 Eli Party candidate.
9. I have appointed the following person to act as my g Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
C aV O Lyl F Woo -s
11. Mailing Addre4s 12. Telephone
0 3 (� �e,�� ( 90'I ) 24/ • 81/3
13. City 14. County 15. State 16. Zip Code 17. E-mail address
,Mt-laA.L $-e.a-c h Ovecl fit,. 322 3 3 Gwoodss Goa,Jo. �s
18. I have designated the following bank as my [v]/ Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
&(-110 /0 3/ / 4 c ✓�/VC/
21. City 22. County 23. State 24. Zip Code
MIavt4-1.v $ -D,)Ya1 1l_ 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 ' 26. Signature ndida
20/S X
27. Treasurer's Acceptance of Appointment(fill in the blanks and eck the appropriate block)
, do hereby accept the appointment
JJ (Please Print or Type Name)
designated above as: 1=d Campaign Treasurer ❑ Deputy Treasurer.
20�s x C' r
Date Signa of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.