Waters- Campaign Treasurer Appt.- Martina Blythe Waters 6-4-15 Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JUN 4 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 . CHECK APPROPRIATE BOX(ES) :
[ ] Initial Filing of Form Re-filing to Change: ■ 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)
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4. Telephone 5 . E-mail address 14 (_ -eack , .32- 2- ;
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6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
// applicable:
Ct h COywniSSibeicl S eat- ❑ 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 a NNo'P
rty Affiliation E. Party candidate.
9 . I have appointed the following person to act as my El Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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'11 . Mailing Address 12 . Telephone
\ 6t Sew I rule )i-md ( 1011 ) 13 ` i - 33 (c )
13. City 14. County 15. State 16. Zip Code 17 . E-mail address
mekko- 'ic ticacivi Pact L- 3 'L2. 33 bl 1t tI-cr5 i i I . cakI,
18. 1 have designated the following bank as my [" Primary Depository _ Secondary Depository
19. Name of Bank 20. Address
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21 . City 22 . County 23. State 24. Zip Code
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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
J cn Y' c M5 j , zAA/' 1, cci`7-n.-,
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I N� 1 + r v w VirS , do hereby accept the appointment
(Please Print or Type Name)
designated above as: [r Campaign Treasurer Deputy Treasurer.
Za \ X (711trk - iptt,( v v OZV-/LAVw)
Date Signature of Qdmpaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001 , F.A.C.