Gary Pyott - Registration Documents APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RECEIVED
DEPOSITORY FOR CANDIDATES
OFFICE OF CLERK
(Section 106.021(1), F.S.) 1
TY
(PLEASE PRINT OR TYPE)
UG ; 2 2024
NOTE: This form must be on file with the filing 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 1 T 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) ,
CL-o
0
4. Telephone: 5. Candidate's Voter Registration#: 6. Email Address: �.
(not required for qualifying purposes) w
7. Office Sought(include district, circuit, group, or seat#): 8. If a candidate for a nonpartisan office, check the box
if applicable:
❑ I intend to run as a Write-In Candidate.
9. If a candidate for partisan 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: rWcampaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer: 12. Telephone: 13. Email Address:
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. Name of Bank: 20. Address:
21. City: 22.. County 23. State: 24. Zip Code:
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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 THAN THE FACTS STATED IN IT ARE TRUE.
26. Sig r Can �e: �
25. Date: .e-ZA a
C
27. Treasurer's Acceptance of Appointment (fill in the blanks alid#e&the appropriate box)
do herebyaccept the appointment d
(Please Print or Type Name) p pP designated above as:
ampaign Treasurer. ❑ Deputy Treasu
29. Si nat f paig Tr surer or Deputy Treasurer
28. Date: v2
DS-DE 9 (Rev.09123) Rule 15-2.0001, F.A.C.
OFFICE USE ONLY
RECEIVEDSTATEMENT OF
OFFICECANDIDATE 1
(Section 106.023, F.S.)
(Please print or type) AUG 1 2 2024
CITY OF AVENTURA
candidate for the office of
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X / e
ig to 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(05111)
City ®f
RECEIVED
AvAr;;%;nturaOFFICE CITY
2024 Special Election
q
Access to tile Candidate and CampaimTreasurer Handbook
and
e Flection laws of the State of Flofida
Candidate: 1
(Print Name)
Office Sou hgLt°.
Commissioner Seat 2
I acknowledge that it is my responsibility to read, understand and follow the
requirements described in the City of Aventura Special Election Candidate
Information resources available on the City of Aventura Website
( .cityofaventura.co ), including but not limited to:
Candidate and Campaign Treasurer Handbook; Compilation of the Election Laws of the State of
Florida; City of Aventura Charter and Code of Ordinances; City of Aventura Political Sign Code;
List of City Vendors; Voter Registration Guide; Items for Sale from Miami-Dade County Elections
Department; Campaign Financing Forms; Frequently Asked Questions; and Common Reporting
Compliance Errors; as well as website ink the Miami-Dade County Elections Department and
State of Florida Division Elec "
Acknowledged by:
t�igdat e Candidate
Date: i
Primary Telephone Number:
Alternate Telephone Number:
E-mail address: = d
PHONE: 305-466-8901 Fax: 305-466-8919
www.cityofaventura.com