Ford -DSDE 9- Appt. Deputy Treasurer- Curtis Ford 2-9-22APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
Izt r Y rU' D
A
FEB 0 9;,022
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NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1 99ECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office iJ Party
2. Name oQandidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)
(_R4h/ 61)
4. Telephone 5. E-mail address
('a'1) 333 V �e
6. Office sought (include district, circuit, group number) C.
%/17 e/ CBmmisSioaet --S(. 1
8. If a candidate fora partisan office, check block and fill in name of party as applicable: My intent is to run as a
/ Party candidate.
9. I have appointed the following person to act as my El Campaign Treasurer 11 Deputy Treasurer
10. Name of T urer or Deputy Treasurer
11. Mailing Address
�3 I /3PAc t4 it
13. Fity 14. County 15. State
342 �` J»vl' l af-i�rfcL kr'MV 1 @ nu4/L -0
18. I have designated the following bank as my r. Primary Depository ❑ Secondary Depositgry)
19. Name of Bank 20. Address
IA) ( /I") F4 030 2 33 At
21. City 22. County 23. State 24. Zip Code
41 04111 r. / t'4 Ai11141 32 2$'
8e4eh Ave
h�+il e„„ A114 (-Beal 32 33
7. If a candidate for a nonpartisan office, check if
applicable:
❑ My intent is to run as a Write -In candidate.
ID Write -In ❑ No Party Affiliation El
16. Zip Code
12. Telephone
(4 0 ) 3334( '
17. E-mail address
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 gt re of Candi(at
29/22— X
27. Treasure ' cceptance of Appointment (fill in the blanks and check the appropriate block)
eff ,3 r\mdL l Kr
J'
(Please Print or Type Name)
designated above as: J Campaign Treasureruty Tr easu er.
, do hereby accept the appointment
2/41121
% Efate
DS -DE 9 (Rev. 10/10)
X
SignNa-uf"Gdmpa' Tre surer or Deputy Treasurer
Rule 1S-2.0001, F.A.C.