Smith- Appt. Campaign Treasurer- James Smith- 6-3-15 Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN JUN 3 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) :
pir4 Initial Filing of Form Re-filing to Change: ■ Treasurer/Deputy ■j 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)
JAMEc C0IM> . 1 . Sl I
4. Telephone 5 . E-mail address / 3 0 c6i4 15 t 1] C OR
( clog ) 60 t - ttoo Jrwte .s' � cvr8obete_ . lAe4 11- ; usts3 tC- geotACt-'1t EL- 322- 33
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
_ applicable:
c O M M t SS t Do CA ^ S € vri 3 ii 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 .I Party candidate.
9 . I have appointed the following person to act as my El Campaign Treasurer Deputy Treasurer
10 . Name of Treasurer or Dep
t )
ty Treasurer
‘) Pc Mke S" 0 tivi, 4 w- 5 f\-'14 -1- 14
11 . Mailing Address 12. Telephone
—7 43 oC - AMscoe pa (qOY ) cog - 1 , a0
13 . City 14. County 15. State 16. Zip Code 17. E-mail address
tft`Lt -C LC- _ Evactit QuvAlp.._ -32233 j two cec civcoi 0e+
18. I have designated the following bank as my igg Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
—tel-A-6 f1Acx- coNv ' LL..c, 8iNtr ¶ o YflLAWfC EL'JD -
21 . City 22 . County 23 . State 24. Zip Code
ILIEV-1131\1 &.- BreACk pvN/ AL- 4le 3 .22- Cka
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 A . * . eTh
f5 Ihiii
t 1
..i.bithi 27. Treasurer's Acceptance of Appointm : nt (fill in he bl : nks and -heck the appropriate block)
ra MISS j • S� I -rt--1 `
I , � - , do hereby accept the appointment
(Please Print or Type Name)
designated above as: j Campaign Treasurer P -,, uty Treasurer.
•IIIIIIr if
,ill
6 . 1l f5 AllkIlliiiiit4
Date alli ignatu r- of ampaign Treasurer or Deputy Treasurer
DS-DE 9 ( Rev. 10/10) Rule 1S-2.0001 , F.A.C.