Lagner - DSDE 9- Appt. Treasurer- Jennifer Lagner- 6-7-22 --- _ -1111. -II I _I _,
APPOINTMENT OF CAMPAIGN TREASURER Rr .77,7,D
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES JUS! - 7 2022
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) BY.
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. _ OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
21 Initial Filing of Form Re-filing to Change: El Treasurer/Deputy [] Depository 0 Office 0 Party
2. Name of Candidate (in this order: First, IMidddlleLast) 3. Addressdr7 (include-poost office box or street, city, state, zip
L"` f rte— code (v -- T ' r I( A
4, Telephone 5. E-mail address L &C-th
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6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
C'_ (r)L,00 .0L-KQry H 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 [J No Party Affiliation El Party candidate.
9. I have appointed the following person to act as my Er Campaign Treasurer Ei Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address 12. Telephone
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13. City 14. County 15. State 16. Zip Code 17. E-mail address
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18. I have designated the following bank as my ID Primary Depository El Secondary Depository
19. Name of Bank
20. Address
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21. City 22. County 23. State 24. Zip Code
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-)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. Si.nature of Candidate
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27. Treasurer's Acceptance of Appointment (fill i he •�nks and check the appropriate block)
je--nOt , do hereby accept the appointment
(Please Print o Type Name)
designated above as: ' Campaign Treasurer Deputy Treasurer.
Date ig tur- of Campaign Treasurer or Deputy surer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.