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Filing PapersRECEIVED APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN OCT 13 2020 DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) CITY OF BOYNTON BEACH CITY CLERWS OFFICE (PLEASE PRINT OR TYPE) d VD, U� rr1 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 Refiling 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 ,,6'1l Y t�A' OL! . 11011, �t �,1 Code) t� jTV n + j0 {kL4-3, 13t'- v i rj~ 3 3q;"`�'�j� 4. Telephone 5. E-mail address (G',54 710 1 at, Loy% - K tw 6. Office sought (include strict, circuit, group numder) 7. If a candidate for a nonpartisan office, check if Ua ri hwe'--,v C4� 60-A ty ,1 SSS �V� applicable: } l © My intent is to run as a Write -In candidate. 8. If a candidate for aa�an office; check block and fill in name of party as applicable: My intent is to run as a E] Write -In No Party Affiliation ❑ Party candidate. 9.1 have appointed the following person to act as my Campaign Treasurer ® Deputy Treasurer 10. Name of ,Treasurer or Deputy Treasurer 11. Mailing Address 1.2. Telephone 13. City - 14. County 15, State 16, Zip Code 17. E-mail address 313 4) 1),,(A 18.1 have designated the following bank as my Primary Depositoii� ❑ Seco ary Duos` rD' 19. Name of Bank T f 20. Address Y l i tJt J 1 % 70 i (".'€ ' S's r 21. City 22, County 23. State 24. Zip Code 06L wR -t' tC L -33ia�� t L nanteaenarnaaeeear+�.. - ^-� _ _ UNDER PENALTIES OF PERJURY, t DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STILTED IN IT ARE TRITE. 25. Date 26. Signature of Candidate 27. Treasurer's Acceptance of Appointment (6l i)he blanks and 06 he appropriate block) 1, � OLy , do hereby accept the appointment (Please Pho or Type Name) designated above as: Campaign Treasurer ❑ Deputy Treasurer. 0 120 J Date igna ure of Ca ai Treasurer r _putyTreasurer DS -DE 9 (Rev. 10/10) `� Rule 1542.UU01, F.A.G. (Section 106.023, F.S.) (Please print or type) O -A et candidate for the office of F OFFICE USE ONLY RECEIVED OCT 13 2020 CITY OF BOYNTON BEACH CITY CLERKS OFFICE 0 C., ,—O -vv, -13M f - Cfh have been provided access to read and understand the requirements of Chapter 106, Florida Statutes. 8ignat60f Candid a66 Dafe 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 (051; 11)