Woods- Deputy Treasurer Appt.- Robin Soergel- 5-28-15 APPOINTMENT OF CAMPAIGN TREASURER Received
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES MAY 2 8 2015
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) Office of City Clerk
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1 ECK APPROPRIATE BOX(ES):
).45
DIU Initial Filing of Form Re-filing to Change: reasurer/Deputy El Depository 0 Office El Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
Carolyn Woods g8 Nth Street
4. Telephone 5. E-mail address Atlantic Beach, FL 32233
(904 ) 241-8973 woodsformayor @gmail.com
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
Mayor El 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
El Write-In E] No Party Affiliation [J Party candidate.
9. I have appointed the following person to act as my El Campaign Treasurer MI Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Robin Soergel
11. Mailing Address 12. Telephone
336 9th St. ( 904 ) 228-8973
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Atlantic Beach Duval FL 32233 woodsformayor @gmail.com
18. I have designated the following bank as my E/ Primary Depository ED Secondary Depository
19. Name of Bank 20. Address
Wells Fargo 1031 Atlantic Blvd.
21. City 22. County 23. State 24. Zip Code
Atlantic Beach Duval FL 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. Sig a of CI idate
May 21, 2015 X
i
27. Treasurer's Acceptance o Appointment(fill in the blank - d check the appropriate block)
-
) Q�S , do hereby accept the appointment
(Please • i <or Type Name)
designated above as: r►', Campaign Treasirrpr f Deputy Treasurer.
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Date /Signature of C paign Treasurer or Deputy Treasurer
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