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CANDIDATE COVER SHEET
THE COMPLETION OF THIS SHEET WILL FACILITATE THE
OPENING OF YOUR CAMPAIGN ACCOUNT BY OUR OFFICE
PLEASE PRINT
NAME AS YOU WANT IT TO APPEAR ON THE BALLOT
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1 MAILING ADDRESS:
RESIDENCE ADDRESS:
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CITY/ZIPCODE:
CITY/ZIP CODE:
TELEPHONE #1:
DAYTIME:
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OFFICE SOUGHT
DATE:
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TELEPHONE #2:
DAYTIME:
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E-MAIL:
(LIST ONE ONLY)
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DISTRICT (IF APPLICABLE)
DATE OF BIRTH m
VOTER ID #:
PARTY (IF APPLICABLE)
CANDIDATE SIGNATURE:
07-01 SOE APPROVEd/
NOTE:
CANDIDATES PROVIDING AN EMAIL ADDRESS, may be
contacted by this office, via email, for situations exclusive/v
involving the candidate. All mass mailings to candidates, from
this office, are done via United States Postal Service.
PHILINDA A. YOUNG
Supervisor of Elections
P 0 BOX 2545
Fort Myers FL 33902-2545
Telephone (339-6300)
FAX (339-6310)
w e b - s i t e : leeelections.com
fiPPOINTMENT OF CAMPAIGN TREASURER AND DESiGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
Section 106.021( 1) FS
CHECK APPROPRIATE BOX
ORIGINAL APPOINTMENT(DEPUTY TREASURERnREAPPOINTMENT
P
OF TREASUREROSECONDARY
DEPOSITORY
PLEASE TYPE OR PRINT
Name of Candidate AS YOU WANT IT TO APPEAR ON BALLOT)
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Telephone (Daytime)
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Address (include P 0 Box, street, city, state,
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Party (Partisan Candidates Only)
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Office Sought (include district, circuit or
group number)
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Campaign Treasurer
I have appointed the following person to act as my
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c l Deputy Treasurer
Name of Treasurer or Deputy Treasurer
Mailing Address (if P 0 Box or drawer add street address)
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County
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c l Primary Depository
I have designated the following named bank as my
Secondpry Depose
EASURER’S ACCEPTANCE OF APPOINTMENT
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, do hereby accept the appointment as
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(Print or Type)
Campaign Treasurer
c l Deputy Treasurer
for the campaign of
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candidate to the office of
who is seeking nomination or election as a
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(ParW)
o u n t y ,
. As a duly registered voter in/ C-f-e
Florida, I am quaufied to accept this appointment.
’
Sfgnadre of Campaign Treas&er or Deputy Treasurer
DS-DE 9 (Rev 11/95)
This form has been modified for Lee County only.
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Date Signed
04-99 DOE APPROVED 94-99
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STATEMENTOFCANDIDATE
LEECOUNTY-FLORIDA
FLORIDA STATUTE CHAPTER 106.023
Each candidate must file a statement of candidate with the qualifying officer
within 10 days after he files his Appointment of Campaign Treasurer and
Designation of Campaign Depository, stating that he has read and
understands the requirements of this chapter.
STATEMENT OF CANDIDATE
PLEASE PRINT
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Name of
, candidate for the office of
ndidate
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Dk’;t save
Office Sought (inclucfb district circuit, or grow number)
I
received, read, and
understand the requirements of Chapter 106, Florida Statutes.
wianature of Can&date
THIS DOCUMENT MUST BE SIGNED AND RETURNED TO THE OFFICE OF THE
SUPERVISOR OF ELECTIONS WITHIN 10 DAYS
MAIL TO:
Qualifying Officer
Lee County Elections Office P 0 Box 2545
Fort Myers FL 33902-2545
IN PERSON:
Lee County Constitutional Complex
Lee County Elections Office 3rd Floor
2480 Thompson Street
Fort Myers FL 33901
IF YOU HAVE ANY QUESTIONS CONCERNING THIS FORM
CALL 339-6300
Mar-99
Philinda A. Young
Supervisor of Elections
Lee County - Florida