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Ford -DSDE 9- Appt. Treasurer- William G. Hillegass 2-9-22
APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) `ira TvitrID FEB 0 9 2022 BY: 941 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 ❑ Party 2. Name of Candidate 'n this order: First, Middle, Last) 3. Address (include post office box-�1 or street, city, state, zip � Ckkns 4-4(. 4-L / ^Q code) J 3 /347V-# �/vK� 4. Telephone 5. E-mail address ,qrmyvT7G A� ! cL- ( 9,o ) 333 - ysw" casfknvekmli v'1 P%14n / co,n 3.-.2-33 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if /(fl7nt(s/,ieK_ �J applicable: Jt -L n 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 El Write -In ❑ No Party Affiliation fl Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer 0 Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer (A r (4l c g� 11. Mailing Address 4)7 3 i2L 13. City r 14`County j KSoN ✓I u- ` (-f Ou u m_ S�2 6ie- -�f- 15. State 12. Telephone ( ) ,2q 0 7/ 3 16. Zip Code 17. E-mail address 18. I have designated the following bank as my [' Primary Depository ❑ Secondary Depository 19. Nart; of Banff S 4( 21. City JAL SOP (— 22. County B c/4c' U t 4-c- 20. Address 33 23. State eco Q, 074 3 yD �R i 24. Zip Code 3 3 DSr3 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 STATEDTEIN IT ARE TRUE. 25. Date 26. Sign ureof Candidate 2/ f/ Z..X 1.• 4 27. Treasurer's Acceptance of Appointment (fill in the blanks and c -ck the appropriate block) 4y in))1(./ /9-11n C , /-// L LES S (Please Print or Type Name) designated above as: [r Campaign Treasurer , do hereby accept the appointment EiDeputy Treasurer. J/ 2 X wLAAA0Ant, _ A--/-2i2sLIcsua DS -DE 9 (Rev. 10/10) bate Signature of Campaign surer or Deputy T surer Rule 1S-2.0001, F.A.C.