Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Grant - DSDE 9 - Appt. Deputy Treasurer- Thomas Clayton Grant 3-6-20
ECEOVE APPOINTMENT OF CAMPAIGN TREASURER LU) AND DESIGNATION OF CAMPAIGN MAR 6 2020 DEPOSITORY FOR CANDIDATES J (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 1. CHECK APPROPRIATE BOX(ES): [D Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party 2. Name of Candidate(in this order: First Middle, Last) 3. Address (include post office box or street, city, state, zip f -- f code) ��►,,�, s CIS, �, '-'1 ICI v�-1- j 9 o c, S k,,t., N/1,1,', '/,', 1 - 4. Telephone . E-mail address (501 ) (2 I @-1141 +(5+vv,t' 36171G t vlAm i I,,Ct:t� t -` k v, f 1 � i t �I�, �L 3 3 3 6. Office sought(include distr , circuit', group,number) 7. If a candidate for a nonpartisan office, check if C0,11 VV1 c SS;c;1e Y-- _ ,-,,.i- 3 _ bI ST(;et applicable: v 1 7 .1- ❑ 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 ❑ No Party Affiliation ❑ Party candidate. 9. I have appointed the following person to act as my ❑ Campaign Treasurer Q Deputy Treasurer 10. Name of Treasurer or Deputy Treasure ��r�l oIVv:-. CI V -10� �t 11. Mailing Address / . 12. Telephone 3L�3� 1C10CI SeIv� 1 P\ifteN; br. (`(O1 ) ("(;)1(,,, - 13S1 13. Ci 14, County 15. State 16. Zip Code 17. E-mail address 14-+ItAvd I,c-13-e,,c1, ,Nov,;,) f:. t, 32-2_3 ft eff►vi5 3 0 lit, f vii, I, <c:vk 18. I have designated the following bank as my © Primary Depository 0 Secondary Depository 1 yame of Ban 20.Address S�L,� .._{({A ;� U0 ,bV, 130 -1- 4tkv vc 3Iwj 21. City 2 County 23. State 24. Zip Code I f iQVIe g•e6N Vk/,:, 1- I. - 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. Signa GrO of Can date' /C, /2L, X 27. Treasurer's Acc tance f App�tment ( ill in the blanks and check the appropriate block) I, Th6mk 5 Clay�v� :--I`r€'1 do herebyaccept the ointment � P PP (Please Priht or Type Name) designated above as: ❑ Campaign Treasurer ® DPer�uty Treas er. --- 3 1 -'31 70 X r,, ti Date Signature of Campaign Treasurer r Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.