Kelly- DSDE 9- Treasurer- Margaret Seiler 5-25-17DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
mw 2 5 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):
10 Initial Filing of Form Re -filing to Change. ❑ Treasurer/Deputy ❑ Depository ❑ Office p Party
2. Name of Candidate (in this order: First, Middle, Last)
Q�c_e Lee Vee_
3. Address (include post office box or street, city, state, zip
code) l el l WWcLgv'R+
'�n
d'
4 Telephone
1 5. E-mail address
R)i))4%35
LMk)5�UL mu/'1
6. Office sought (include district, circuit, groupUmber)
&!al y�
7. If a candidate for a nonpartisan office, check if
130((1
applicable:
RHIJI)+Y1 ch Ci 6Dm rn z)u—
❑ 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 parry as applicable: My intent is to run as a
Write -In E] No Party Affiliation Party candidate.
9. I have appointed the following person to act as my Lam, Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Tr asurer
�.' Seer
11. Mailingddr ss
12. Telephone
C6 6 ^ NI
(04) (0 -007? -
13. City
cKvlll��3egch
14. County
Duval
15. State
16. Zip Code
3�'ISU
17. E-mail address
18. 1 have designated the following bank as myPrimary Depository Secondary Depository
19. Name of Bank �U
2 dd�ress 6fi, BlI,tJ
U
g[' T/-233
21. Ci
22. County
State
FL
24. Zip Code
3aa33
HINDER PENAI rr s -P 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 h
26. Signature of Candidate
X CLL
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, i \'. j D,,,/r0'4;� ( , do hereby accept the appointment
""�`�J (PI�e��yyye Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
z� I l �' k�J�" "
d
Date Signature CAimpaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.