Fillable Dsde9 COMMITTEES OF CONTINUOUS EXISTENCE (City of Marco Island Florida)

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Dsde9 COMMITTEES OF CONTINUOUS EXISTENCE (City of Marco Island Florida)

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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.
OFFICE USE ONLY
1. CHECK 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 (include post office box or street, city, state, zip
code)
4. Telephone
( )
5. E-mail address
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
applicable:
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
Campaign Treasurer
Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address
12. Telephone
( )
13. City
14. County
15. State
16. Zip Code
17. E-mail address
18. I have designated the following bank as my
Primary Depository
Secondary Depository
19. Name of Bank
20. Address
21. City
22. County
23. State
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 IT ARE TRUE.
25. Date
26. Signature of Candidate
X
27. Treasurer’s Acceptance of Appointment (fill in the blanks and check the appropriate block)
I,
, do hereby accept the appointment
(Please Print or Type Name)
designated above as:
Campaign Treasurer
Deputy Treasurer.
X
Date
Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.
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Dsde9 COMMITTEES OF CONTINUOUS EXISTENCE (City of Marco Island Florida)

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Completed 10 June 2021

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