Kelly - DSDE 9- Appt. Treasurer- Candace Kelly- 7-8-22 APPOINTMENT OF CAMPAIGN TREASURER �
AND DESIGNATION OF CAMPAIGN Rr ��
t , .VED
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) JUL 0 8 2322
(PLEASE PRINT OR TYPE) BY: 8
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Ni Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2..Nida
L-E��Name of Candidate (in this orrdd�effr:++First, Middle, Last) 3. Address (include post office box or street, city, state, zip
CC0- t-U ly code) Iv Pr
4. Telephone 5. E-mail address - �y I
( O ) 35c/- `C- 1 <e1 Isa0 mmvL ca i (419)1—ch Ft=
6. ffice ought (in ucJe di ict, clr ult, group number) 7. If a candidate for a nonpartisan office, check if
Ci frt�► 11` applicable:
/ Olrn r` saf 1 / 13 00 ❑ My intent is to run as a Write-In candidate.
W 1 l
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
0 Write-In ❑ No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my E' Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer,oy Dr uty Treasurer
11. Mailing Address 12. Telephone
11142 S/1141 ` ( oil )$Sq-y38'7
13. city 14. County15. State ' 16. Zip Code 17. E-mail address
r-+1 iiia el nava 1 FL ...3-;) -33 c Kol ly tso Caama I I . coil
18. I have designated the following bank as my �' Primary Depository ❑ Sec no dary Depository
19. Name of Bank 20. Address
(\-merS ink' S1 D fflaA +lc 811/ci
21. ity 22. County 23. State 24. Zip Code
O � P Ou vc 3),-),&&
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. Signature of Candidate
-34 kiga x CL 1
27. Treasurer's Acceptance of Appointment (fill in the blanks and eck the appropriate block)
I, can a,�:P
\ 'eII)' , do hereby accept the appointment
(Please Print or Type Name)
designated above as: [ Campaign Treasurer ❑ Deputy Treasurer.
Date Signature of Ca aign Treasurer or Deputy Treasurer
`
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.