Hill- DSDE 9- Treasurers- Lisa Herrold 3-10-17APPOINTMENT OF CAMPAIGN TREASURER
Received
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
MAR 1 0 2017
(Section 108.021(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
James Kelly Hill
fie)
372 7th Street
4. Telephone
5. E-mail address
(904 ) 7592758
boattimel @yahoo.com
Atlantic Beach FL 32233
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
applicable:
Commissioner Seat 4
❑ My intent is to run as a Write -In candidate.
8. If a candidata fora RNOW office, check block and fill in name of parry as applicable: My intent is to run as a
❑ Witte -In �_' oParty Affiliation ❑ Party candidate.
9. 1 have appointeiiiiiis following person to act as my
Q Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Lisa Herrold, Treasurer
11. Mailing Address
12. Telephone
659 Sherry Drive
( 904 ) 3863325
13. City
14. County
15. State
16. Zip Code
17. E-mail address
Atlantic Beach
Duval
FL
32233
1
1 t rro
o
18. 1 have designated the following bank as my ❑✓ Primary Depository ❑ Secondary D46sitory
19. Name of Bank
20. Address
Regions
115 3rd Street
21. City
22. County
23. Slate
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. S" lure of e
9 r7
x
27. Treasurer's Acceptance of Appoimme In the blanks and check the appropriate block)
Lisa Herrold
, do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign T ❑ Deputy Treasurer.
3/10/lj x ,.
Date ;ignaqjm of Campaign Treasurer or De rer
DS -DE 9 (Rev. 10010) Rule 1S2.0001, F.A.C.