Grant - DSDE 9 - Appt. Treasurer- Tina Marie Grant 3-6-20 ECL OV
APPOINTMENT OF CAMPAIGN TREASURER D
AND DESIGNATION OF CAMPAIGN YAR p 2012
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
1. CHECK APPROPRIATE BOX(ES):
X� Initial Filing of Form Re-filing to Change: EI Treasurer/Deputy El Depository Office EJ Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
Thomas Clayton Grant code)
1909 Selva Marina Drive, Atlantic Beach, FL 32233
4. Telephone 5. E-mail address
(904 ) 616-4354 tcgtmg3@hotmail.com
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
Commissioner- Seat 3 - District 1307 applicable:
El 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
ID Write-In El No Party Affiliation El Party candidate.
9. I have appointed the following person to act as my ® Campaign Treasurer 1=1 Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Tina Marie Grant
11. Mailing Address 12. Telephone
1909 Selva Marina Drive ( 904 ) 322-2499
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Atlantic Beach Duval FL 32233 tcgtmg2@hotmail.com
18. I have designated the following bank as my E] Primary Depository 0 Secondary Depository
19. Name of Bank 20. Address
Vystar Credit Union 1307 Atlantic Blvd
21. City 22. County 23. State 24. Zip Code
Neptune Beach Duval FL 32266
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 IN IT RE, UE.
25. Date 26. na r of ndidate
03/06/2020
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Tina Marie Grant , do hereby accept p the appointment
(Please Print or Type Name)
designated above as: ❑X Campaign Treasurer El Deputy Treasurer.
03/06/2020 X
Date ( Signature 0 Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.