Glasser- DSDE 9- Appt. Deputy Treasurer- Ellen Glasser 3-12-20 ECE
APPOINTMENT OF CAMPAIGN TREASURER Q v E ,
AND DESIGNATION OF CAMPAIGN
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DEPOSITORY FOR CANDIDATES IMAR 1 2 2020 J
(Section 106.021(1), F.S.) -J
(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):
0 Initial Filing of Form Re-filing to Change: E1reasurer/Deputy El Depository El Office El Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state,zip
Ellcode)
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4. Telephone 5. E-mail address L 3 Z ? 3 3
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6. Office sought (include dis�ct, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
OW) J C eK_ I 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 El Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address r 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 rimary Depository-J ❑ Secondary Depository
19. Name of Bankn 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. Signature ofCandidate
311212 X 04-;:2-z--------
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, C . L.A–(- Si G ( A 33 -2 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: El Campaign Treasurer Deputy Treasurer.
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Date Signature of Campaign Treasurer or Deputy Treasurer