Beckenbach- Appt. Campaign Treasurer- Mark Beckenbach 5-14-15 Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN MAY 14 2015
DEPOSITORY FOR CANDIDATES p
(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):
21 Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository p Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
VNT .d3p6-d<E1‘( c-14 code) .221 t5 QG�!{N(,JAa DR. Li
4.Telephone 5. E-mail address A-11.,A tJiIL �J��L14 rt
(91'1) 5 Q iECyc c ehRKe GnU+w. 3 2-2-3->
6. Office sought(include district, circuit, group number) i'� 7. If a candidate for a nonpartisan office,check if
applicable:
C.fjli'tI I 55 i Nk s 6/V3 ❑ 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 f Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
ARK C 13 64 I
11. Mailing Address 12. Telephone
22-%0 o c...64/ A uC 12. 4.1 ( /) 06
13. City 14. County 15. S to 16. Zip Code 17. E-mail address
ATLA i1 13( A<-11 VP( L. L- )),2-33 1 Ec-i4�N r, - /We 6-At I t,. <-v'r7
18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20.Address
73/TAW ter' Am E'ZI L.,41 5r/ T I1D ST AieroN5
21. City 22. County 23. State 24. Zip Code
N -prova-- egeA(.4- -pa v a >% 32.266
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 T E FACTS STATED IN IT ARE TRUE.
25. Date 26. Si Fr Candi•
5 hi-///.5-
X ti
27. � Treasurer's Acceptance of Appointment( in the blanks and check the appropriate block)
(f
/ t
I, ' K -56C,._K /4,-,-1-1 , do hereby accept the appointment
(Please Print or Type Name)
design ted above as: Campaign Treasurer Deputy Tr-. urer.
Py
Date Signatu of C-mpaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10110) Rule 1S-2.0001, F.A.C.