Mark- Appt. Campaign Treasurer-Maria Mark 2-6-15 Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN FEB - 6 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):
EI Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository 0 Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
code)
/far�'c�.� !Y)Cyk 1 I y $ Li.n kS i d* -D r; u e,
4. Telephone 5. E-mail address
mar mari(-C3 <'nk'«,rj .5 ) , rc 312_33
90Y ) 7 Or4 35-8V
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
�3 n'Ami s S I o rl-er applicable:
/ 30 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 ❑ Party candidate.
9. I have appointed the following person to act as my M Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
m&r, cr 7 . mark
11. Mailing Address 12. Telephone
1 i L JihkS(cte. Tbr (gay ) 7()/ . 3:c3(-1
13. City 14. County 15. State 16. Zip Code 17. E-mail address
r L 32233 /`nar ladfrau-/LCa yrr (. COrr..,
18. I have designated the following bank as my ® Primary Depository ❑ Secondary Depository
19. Name of Bank 20.Address
0X11 s 1=cr50 ) o 3 J 1)/fan ti f3)vc)
21. City 22. County 23. State 24. Zip Code
p .)14.rd-i (■. i r` 3 233
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 of Candidate
ao (o, awl �I•a X c.(✓C k .i'U
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, mat'/Cr - War , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer.
/) O,Axi AO/S- X c,(..t c
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.