Norris -DSDE 9- Appt. Deputy Treasurer- Brittany Norris 1-28-22APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
JAN 2 4 2022
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 ❑ Depository ❑ Office p Party
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
�2 AVa , r 1 `l 9, �� code) \ voVe ` s'w' _
4. Telephone 5. E-mail address lackL
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
applicable:
❑ My intent is to run as a Write -In candidate.
8. If a candidate for a partisan 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. I have appointed the following person to act as my ❑ Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address
1\ eA Wt -1-
13. City 14. County
18. I have designated the following bank as my
19. Name of Bank
Luels
21. CityAatn, M, n CLOk
22.
22. County
15. State
Ca -
16. Zip Code
3Z7`33
12. Telephone
(C\17 )73GZtji-
17. ma I address
\Y1 vue c cc�J
Primary Depository ❑ Secondary Depository
20. Address
(63\ (C4
23. Stat
24. Zip Code
z 2`-25-7)
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. Sigrture of Cate
27. Treasurer's Acceptance of Appointment (fill in thnks and check the appropriate block)
(Please Print or Type Name)
designated above as: J Campaign Treasurer Deputy Treasurer.
\ /7 -,11'7 a x 1
Date
, do hereby accept the appointment
ture of Campaigrr reasurer or Deputy Treasurer
DS -DE 9 /Rev_ 10/101 Rule 1S-2.0001. F.A.C.
i