Norris -DSDE9- Treasurer- Lauren Spencer 3-21-17DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
MAR 2 1 2017
(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 -fling to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Parry
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
1
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6. Office sought (include district, circuit, gropup number)
7. If a candidate for a nonpartisan office, check if
(,eyuvvy �C.�`7
applicable:M
My intent is to run as aWrite-In candidate.
B. If a candidate foraa� office, check block and fill in name of party as applicable: My intent is to run as a
E] Write -In [-] No Party Affiliation ❑ Party candidate.
-9.- I have -appointed the following person to act as my TR Campaign Treasurer El Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address -
12. Telephone
122Q _DCLW'e
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13. City
14. County
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15. State
-1-L
16. Zip Code
32Zz�;
17. E-mail address
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank C
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21. City
-Au&Vino
22. County
wMAl
23. State
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24. Zip Code
3z-zzti
-LNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THATT ACTS STATED IN IT ARE TRUE.
25. Date
26. Si�tuof at
V40/20a
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27. Treasurer's Acceptance of Appointment (fill in airks and check the appr priate ck)
I, l A Y yl 171CQ Y , do hereby accept the appointment
e se Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
X &A
c3�1 12.01-7 rwsvi'10.11'
Date Signature of CampaigM Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.