Harding -DSDE9- Treasurer- Robert Russakoff 12-1-16 Received •
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN DEC - 2016
DEPOSITORY FOR CANDIDATES
(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):
X❑ Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy El Depository 1=1 Office El Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address (include post office box or street, city, state, zip
Mitchell Ray Harding code)
635 Jasmine Street
4. Telephone 5. E-mail address Atlantic Beach FL 32233
(904 ) 352-6064 mitch.harding62@gmail.com
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
Atlantic Beach Commissioner Seat 5 applicable:
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
p Write-In El No Party Affiliation [ ' F Party candidate.
9. I have appointed the following person to act as my 0 Campaign Treasurer El Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Robert Russakoff
11. Mailing Address 12.Telephone
640 N Camellia Terrace Ct ( 904 ) 476-7223
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Neptune Beach Duval FL 32266 rob@tribalboards.com
18. I have designated the following bank as my ❑X Primary Depository Secondary Depository
19. Name of Bank 20.Address
AMERIS 560 Atlantic Blvd
21. City 22. County 23. State 24.Zip Code
Neptune Beach Duval FL 32266
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. Si. re of Cand'.ate
12/1/16 X 4W/0/; - �•i
27. Treasurer's Acceptance of Appointment(fill in the blanks -nd check the appropriate block'
Robert Russakoff , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Tr-:surer Deputy Treas -r.
12/1/16 X
Date Signatures=mpaign Tre- or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.