Woods- Deputy Treasurer Appt-Change- Carolyn Woods- 5-27-15 Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN MAY 2 7 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: (r 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
code)
4.Telephone 5. E-mail address ,( i ( _ rCrG�I I�
p r a�war-0c:j.Y1L<<�� CO►'Y\ /"��'1 c�.Vl "�
( U1�4 ) 2L( I •8°t/3 dc,cac�s�
6.Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
N4 al O c ❑ 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
Ei Write-In ❑ No Party Affiliation Eli Party candidate.
9. I have appointed the following person to act as my ❑ Campaign Treasurer 7 Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
( av c r U.) occk
11. Mailing Addres 12. Telephone
O 3 ( i-' ( 1 ) 241 , 8 9'1 3
13. City, 14. County 15. State 16.Zip Code 17. E-mail address
Mt . v (.0 3 WcGcks car voczlc,r TvuujCv�n
18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank r, 20.Address
u ks kawg0
21. City 22. County 23. State 24.Zip Code
1ay.+;c .3223
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. Signat of Ca ridate
5. ati .yam
27. Treasurer's Acceptance of Appointment (fill in the blanks check the appropriate block)
I, CX1-11 0('Y\ W'0O d , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer Deputy Tre urer.
- �s X 7� Oce_c
Date Signature of Campa Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.