Glasser- DSDE 9- Appt. Treasurer- Ellen Glasser 2-03-20 IECEOVE]
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN FEB ' 2020
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
11.2C/HtCK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: p 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
(i✓LeN GIPr5.5 '.Z- code)
.p ce'0 BCGct-,
4. Telephone 5. E-mail address /1�,1 , L G� F7--- 3??3
(6/0L1 ) 1.412-(02(02 0\c_`st�C�c o,-)c c_S-f. ,, //J� I
6. Office sought (include distict, circuit, group number) 7. If a candidate for a nonpartisan office, check if
,nnn� I - applicable:
yr V� x{00 1 Se G'J— I ElMy 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
0 Write-In 0 No Party Affiliation ® Party candidate.
9. I have appointed the following person to act as my �ampaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
L(x ) t-e s r---
11. Mailing Address 12. Telephone
tNov $6,j,-, is . (roti ) `f12- 626&--
13. City 14.4. County 15. State 16. Zip Code 17 E-mail address 1
AA1 i9, L ("K‘ . J,u c ( f(--- 3?-2-35 \5 1 c�55c r�e�,," 'c`S-1- ,,,I?-4-
18. I have designated the following bank as my O-Primary Depository ❑ Secondary Depository
19. NameofBank 20. Address
wel \S Fa(-o� `3 a,1,---- l o 3 , o,-'-f - 3 I vC.
21. City • 22. County 23. State 24. Zip Code
/A 0 ,t,3 -(,1-, D1, UL. ( �___ 32233
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
Z b'ZD X 674.-7,
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, /�1 ) S CTGKs-5c, R- , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer.
45//0 X
Date Signature of Campaign Treasurer or Deputy Trearer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.