Filing Papers APPOINTMENT OF CAMPAIGN TREASURER RECEIVED
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES MAR 0 8 2021
(Section 106.021(1), F.S.)
CITY OF BOYNTON BEACH
(PLEASE PRINT OR TYPE) CITY CLERK'S OFFICE
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) vcca.
-OP‘\lIn I ME-120iEtz xemE... #_D
4. Telephone 5 E-mail add ss
aprki\)
r1.41- LcFc oaf
6. Office sought (include district, circuit, group number) •C . If a candidate for a nonpartisan office, check if
applicable:
MAC1( My intent is to run as a Write-In candidate.
8. If a candidate fora partisan office, check block and fill in name of party as applicable: My intent is to run as a
L_1 Write-In 74 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
Dey1Ui ( ‘4eCL.
11. Mailing Address , 12. Telephone
a;u*74- LFA D (5k) X1313- ( fri
13. City 14. County 15. tate 16. Zip Code 17. E-mail address
1 I� ?F Yr e 3343 L.. c�Al��grin .1
Rt
18. I bave designated the following bank as my Primary Depository ❑ Secon•ary:e:asrtol'y Yr
19. Name ofrBank 20. Address
SA`\\L 1801 t-o �N bJ\ 13LVD
21. City 22, County 23. State 24. Zip Code
904\ipv (?3eftIA YA-Lvo FLobnA 33q3G
UNDER ENALTIES 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. ' - ► e of Candidate
1C�Czc- X gh`'t' . ,c)1`cr,f) }ri\
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, tRxi Cr, , do hereby accept the appointment
(Please Print or Type Name)
designated above as: El Campaign Treas rer s pm Deputy Treasurer.
' rnature of C m al Treer br De ut Treasurer
WI-N\ INV ,
ate9 Deputy
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
OFFICE USE ONLY
STATEMENT OF RECEIVED
CANDIDATE MAR 0 8 2021
(Section 106.023, F.S.)
CITY OF BOYNTON BEACH
(Please print ortype) CITY CLERKS OFFICE
I, Dkin MWecl-
candidate for the office of MOtKZ
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
C-AA1k7.'\
\O)Pc
Signature of Candidate Date
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(05/11)