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HomeMy WebLinkAboutRe-filing of DS-DE 9 to change Depository APPOINTMENT OF CAMPAIGN TREASURER D E © E D v E LI AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES JUN 01 2015 (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) ii9—Z7:01„1 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: El Treasurer/Deputy 0 Depository 0 Office 0 Party 2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip Buzz Petsos code) 618 Madison Ave. • 4. Telephone 5. E-mail address Cape Canaveral, FL 32920 (321 ) 799-1876 buzzpetsos@earthlink.net 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if applicable: Mayor, City of Cape Canaveral 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 El No Party Affiliation n Party candidate. 9. I have appointed the following person to act as my n Campaign Treasurer n Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Buzz Petsos 11. Mailing Address 12. Telephone 618 Madison Ave. ( 321 ) 799-1876 13. City 14. County 15. State 16. Zip Code 17. E-mail address Cape Canaveral Brevard FL 32920 buzzpetsos@earthlink.net 18. I have designated the following bank as my ❑X Primary Depository fl Secondary Depository 19. Name of Bank 20. Address Wells Fargo 7801 Atlantic Ave. 21. City 22. County 23. State 24. Zip Code Cape Canaveral Brevard FL 32920 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 Can 'd e 6/1/15 27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block) Buzz Petsos , do hereby accept the appointment (Please Print or Type Name) designated above as: ❑X Campaign Treasurer Deputy asurer. 6/1/15 X Date Signature of ampaign reasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.