Glasser -DSDE9- Change of Depository- DepTreas- Glasser 3-2-17Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN MAR 2 2011DEPOSITORYFORCANDIDATES
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 0 Depository Office Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address(include post office box or street, city, state,zip
Elle', ClGsse/
code)
fix 330c-10
4. Telephone 5. E-mail address Afrf/_ p ` Be4 IL 3L 3 7
go ) 1112 -6zG2 la5Cere@lar,cC3+,2>y
Vti T
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
1t 14 y0,--/ Se44 / 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 Party candidate.
9. Ihave appointed the following person to act as my Campaign Treasurer igi Deputy Treasurer
10. Name of reasurer or Deputy Treasurer
11. Mailing Address 12.Telephone
e , 6 bDx 53Q51 lj4 ) 4-12 - (ozC, z-
13. City 14. County 1 State 16. Zip Code 17. E-mail address
IMI(
L 6(oLi 0W`cI r1-
Arl
3223.3 (r/I439'/ ne@Ca. cK .
nei
18. I have designated the following bank as my s Primary Depositor+j" Secondary Depository
19. Name of Bak 20.Address
Fel() .frac o Io3I Allorc r lvi_
21. City 5 22. C unty 23. Siete 24. Zip Code
A( terf-K- 664(1--, 0(,1/CI I 3Z233
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 f andidate
31 t 1 ( 1 x 7. K
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I,t(/lle71 (/ 46,5 P do hereby accept the appointment
Piease Print or Type Name)
designated above as: Campaign Treasurer Tit Deputy Treasurer.
3i(II/ x G C'1P1/72--
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10110) Rule 1S-2.0001,F.A.C.