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HomeMy WebLinkAboutFiling PapersAPPOINTMENT OF CAMPAIGN TREASURER RECEIVED AND DESIGNATION OF CAMPAIGN JUL 0 6.2021 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S. ) CITY Of BOYNTON BEACH (PLEASE PRINT OR TYPE) CITY CLERK'S OFFICE o2; y,.` 65 - NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY e1. C ECK APPROPRIATE BOX(ES): 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(includepost office box street, city, state, zip _ por code) bDV `8 G�IGv4� 1"�(Lro-, 0 gOYA� 46�' -R'. 3ZL[�s 4. Telephone 5. E-mail addres (5&t )910- E7ZZy� A p� 7©e d1 a�� 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: 0'_i 0 [:] My intent is to run as a Write -In candidate. 8. If a candida a for a partisan office, check block and fill in name of party as applicable: My intent is to run as a Write -In 0 No Party Affiliation I Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer 10. Name pfTr�or Deputy Treasurer 11. Mailing Address 12. Telephone 00 or -�-o (Klo()810-S�7Zz 13. ity 4. County 15- State 16. Zip Code 17. E- ail address 18. 1 have designated the following bank as my Primary Depository El Secondary Depository 19. Name o Bank ". CCS 20. Address 3 D W. WCAOrf 23. State 21. ty 22. C unty eeaLet/L 24. Zip Code 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 25. Date 26. Signature of Ca 67I� Z ( X 27. Tre A urer's Acceptance of Appointment (fill in the blanks and check the appropriate block) TA _ ;I f)f.__ ,0 V • VOC (Please Print or Type Np3ni e) designated aboveCampaign Treasurer ri Deputy Trea: 70 07 (D LZ,. X D to Signature of Campaign DS -DE 9 (Rev. 10/10) , do hereby accept the appointment surer or Deputy Treasurer Rule 1S-2.0001, F.A.C. I STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please print or type) candidate for the office of OFFICE USE ONLY JUL 0 6.2021 CITY OF BOYNTON BEACH CITY CLERICS OFFICE a'r�CG have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. X (j a z 'Sign ature of ndidate batel Each candidate must file a statement with the qualifying officer within 10 days after the Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful failure to file this form is a first degree misdemeanor and a civil violation of the Campaign Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida Statutes). DS -DE 84 (05111)