Norris- DSDE9- Change to Depository- Treasurer Lauren Spencer 3-22-17DS -DE 9 (Rev. 10110) Rule 15-2.0001, F.A.C.
Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
MAR 2 ? 2017
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):
❑ Initial Filing of Form Re -filing to Change. ❑ Treasurer/Deputy 1A Depository ❑ Office ❑ Party
2. Name ofCandidate(in this order. First, Middle, Last) 3. Address (include post office box or street, city, state, zip
6Q(\'Ouy\y M NW—V1,S code)
[IS 3 ��"�
4. Telephone 5. E-mail address
}72_I\'M0121 Cl'n�ti. �ieQ-Ckl \ - 7iZZ3�
aJ\OfLYL\'S
(ah )SSG 36a� _ A. cW11t,
distr didate for a nonpartisan office, check if
6. Office sough[ (include district, circui number)Jt;
ble:
My intent is to run as a Write -In candidate.
8. If a candidate for aap rtisan 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.
1 have appointed the following person to act as my
Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
LauVV,�A S eA00(z-
11. Mailing Address
12. Telephone
lzz0. SkTul\OLv�wl -C7YLN2 Lue`3t
( 3z) ) IAQ 46iAl
13, City
14. County
15, State
16. Zip Code
17. E-mail address
lACICSp LAA -e
wVA1,
FL
3TLZS
n
CQV
LSpe'ric \A M,
18. 1 have designated the following bank as my ®, Primary Depository Secondary Depository
19. Name of Bank
1,ckc,
20. Address
1031 A\`10,0 .c 3\V4
21.ICity
22. County
23. State
24. Zip Code
AA
,. DER 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. Sign re of Candidate
3/21 Z20 \-4-
x
27. Treasurer's Acceptance of Appointment (fill a blanks an shecklhe appropriate block)
/
I, (WkY WAYAlli !SYll , do hereby accept the appointment
Please Print or Type Name)
designated above as: Campaign TreasurerDeputyTreasurer.
/Z I/ 1-7 X
_�ignature r Deputy Treasurer
Date
DS -DE 9 (Rev. 10110) Rule 15-2.0001, F.A.C.