APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
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.
1. CHECK APPROPRIATE BOX(ES):
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
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
_________________________________________ Party candidate.
9. I have appointed the following person to act as my
10. Name of Treasurer or Deputy Treasurer
18. I have designated the following bank as my
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.
26. Signature of Candidate
27. Treasurer’s Acceptance of Appointment (fill in the blanks and check the appropriate block)
, do hereby accept the appointment
(Please Print or Type Name)
Signature of Campaign Treasurer or Deputy Treasurer