Norris- DSDE9- Change to Depository- Deputy Treasurer Brittany Norris 3-22-17DS -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 2 2017
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
Offce of City Cled
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 Refilingto Change ❑ Treasurer/Deputy .521 Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
-g11 _� A .. ,..., 1� code)
Lta "�IXC�tri
gw8 Lrbw-'ll- --Qt-
45. Telephone 1
)p E-mail address
�" �Ynukcw-^
K
@
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
p C - -' applicable:
`CN,I`yY`t sbr.wv Avr_ eak r S ❑ My intent is to run as a Write-In candidate.
8. If a candidate for aaD 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.
9. 1 have appointed the following person to act as my ❑ Campaign Treasurer N Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
6
11. Mailing Addre
12. Telephone
I in vva 6 OA`s )�;
( R12 ) 9512 `2, —4
13. City
fk
14. County
TJVa�
15. State
IF-L
16. Zip Code
I ml,�
17. E-mail address
,>0#V u:X,6eV
18. 1 have designated the following bank as my V, Primary Depository Secondary Depository
19. Name of Bank
1i%e0.5T
20. Address
0
163k k- V\k1k 6\V-r�
21. City
22. County
23. State
24. Zip Code
d -Wmkie _,eco-eh
T)V4\
�1 a�w�a
3zz-S5
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. Sign ur of Candid e n
'7/Zt /_26k7_ X V
27. Treasurer's Acceptance of Appointment (fill in the tanks and check the apprcpr ck)
1, T-7,6w WM Nmw) , do hereby accept the appointment
(Please Print or Type Name)
designated above as ❑ Campaign Treasurer deputy Treasurer
�2i m r _ X
Date Sig atu of C palgn Treasurer or De uty-Treastrier
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.