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Glasser- DSDE 9- Appt. Treasurer- William Hillegass 3-12-20
[E© C OVEi APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES MAR 1 2 2020 (Section 106.021(1), F.S.) _ 14 (PLEASE PRINT OR TYPE) A6 NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): ID Initial Filing of Form Re-filing to Change: i Treasurer/Deputy J Depository 0 Office 0 Party 2. Name of Candidate1 (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state,zip LLLL " CLASSE2 code)20(,o3 6e4c1;Th AV 4. Telephone 5. E-mail address A-I le,-,- L_ \ea. cc (-- L 3 Z 232 ($39 ) 1-02-(0 A 2- c IG SSe re<w r�r.r,c .c(5-{- . .le• . .- 6. Office sought (include disttt, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: A y O RI S e 4,4- ( ❑ 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 ID Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer El Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer W i ( L a 0--) G _ .0', (k C c SS 11. Mailing Address 12. Telephone IA 21 3(-,( SkrP e-r r (9of1 ) 2(16 -0/ (3 City 14. Cou 15. State 16. Zip Code 17. E-mail address .J c,tC,) U. a& L v' C 1 (�L 32Z5-c) lo ( ICc C. k -c_ . r o 18. I have designated the following bank as my I_J Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address ,ki e `3 -G ,�' Gl„ &47\k_ 1,) 3 1 A416,-(1-i L 6 I V C'� 21. City J 22. County 23. State 24. Zip Code A, (o,„k, , _ _.6,.,1-, n,„,), ) L 3 ZZ 33 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 fl ( 2 I 2 L3 Xr'. C(1,;-7 - 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) /j() I L C/, i'1 6 J/ L LF GA 0 , do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer El Deputy Treasurer. I2ti1i2c/L /2, 2a ?1, X bu/z& 4u1 )I7 (/(,)_._ Date Signature of Ca paig Treasurer or Deputy Treasurer