Kelly- DSDE 9- Deputy Treasurer- Candace Kelly 5-25-17DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
MAY 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.
I OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-fling to Change: ❑ Treasurer/Deputy ❑ Depository 1] Office ❑ Party
2. Name (in thi�/o/d1e`I: First, Middle, Last)
elly
3. Address(includepost office box or street, city, state, zip
code)
q GO-
,1to/f'rCandidate
C nl W� LQQ 4
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�-I- �-� I,X//GGh Fl—
Fl—
4. Telephone
1 5. E-mail address I
MIA
MIA )ay�3�
CQ11��drmi
F{
Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
applicable:
I
1p
F] Myintentisto run as a Write-In candidate.
rt�san� office, check block and fill in name of party as applicable: My intent is to run as a
8. If a candidate for a Ra
Write-In ❑ No Party Affiliation ❑ Party candidate.
9, t have appointed the following person to act as my Campaign Treasurer
Deputy Treasurer
10. Na of Tr asurer or Deputy Tfea urer
f
a
11. Maii Ad ess,\ nc�oe 1
tti
12.0Telephone
13Qityt 13ach
County
14.MUa
15ate
16.Z -3Cod
address
C� tl&oG rw1
18. I1IMM,,.hll..ave designated the following bank as my Primary Depository ❑ Secondary Depository
19, ame of Bank
LS
20. Address 1
5W �mv( BIVA
21.
City
,/I,
1 (.J l
Court 23. Sate
WI �
24. Zip (Alde
-3� (Y
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 I�
26. Signature of Candidate
X CL
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, (ma co L do hereby accept the appointment
(Please Print or Type Name)
designated above as: r.
❑ Campaign Treasurer Deputy Treasure
's: fI X
I I IU
` Date Signature of Camp n Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.