Apointment of Campaign Treasurer - Ana Maria WolstenholmeAPPOINTMENT 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 filing officer before
openinq the campaign account.
o R9V991NR D
FEB 13 2025
anw
By:
OFFICE USE ONLY
PPROPRIATE BOX(ES):
Flnitial
9 ng of Form ❑ Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last):
3. Address (include PO Box or Street, City, State, Zip Code):
(Please Print or Type Name)
n I HI V ( G� Vj�)
4. Telephone:
5. Candidate' Voter Registration #:
q 3 0,;
6. Email Address:
a w oL c, rk vA vvq iu
—
for
(not required qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
8. If a candidate for a nonpartisan office, check the box
j m I/
(� 61 C% I Y
if applicable:
❑ I intend to run as a Write -In Candidate.
9. If a candidate for gartisan office, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write -In Candidate. �No Party Affiliation Candidate. ❑ Party candidate.
10. 1 have appointed the following person to act as my: Campaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
12. Telephone:
13. Email Address:
d
14. Mailing Address:
15. City:
16. State:
17. Zip Code:
18. 1 have designated the following bank as my (check appropriate box): ❑ Primary Depository ❑ Secondary Depository
19. Naryle of Bank:
i,1 . t=��.
20. Address:
� ' i�/ntaAve,
n v
21. City: " 22. County. 23. state: 24. Zip c :
' � \� ► -13 tis�'�!, �
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
26. Signature of Candidate:
25. Date:
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
(;a_ tr� r-b ( 1,�
(Please Print or Type Name)
dcampaign Treasurer.
hereby accept the appointment designated above as:
❑ Deputy Treasurer.
29. Signature of C aign Treasurer or Deputy Treasurer
28. Date: a
DS-DE 9 (Rev. 09/23) Ru 1S-2.0001, F.A.C.