DS-DE 9 JGross 1/5/09STATE OF FLORIDA OFFICE USE ONLY
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES ~' ^~
(Section 106.021(1), F.S.) .~ .°o
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Original Appointment ~ Deputy Treasurer ~ Reappointc~i nt ~jfreas~rer
Name of Candidate
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~ 1. Address (include post office box o street, ~~, s~, zip code)
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Telephone (optional) 2. Party (Partisan candidates only) 3. Office (add district, circuit, group number) ~
I have appointed the following person to act as my Campaign Treasurer ~ Deputy Treasurer
4. Name of Treasurer or Deputy Treas,ure''~r
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5. Mailing Address (If post office box or drawer add street address) 6. Telephone
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7. City 8. County 9. State 10. Zip Code
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I have designated the following named bank as my Primary Depository ~ Secondary Depository
11. Name of Bank ,
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13. City 14. County 15. State 16. Zip Code
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17. Signature of didate Date
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Campaign Treasurer's Acceptance of Appointment
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I, Q' ,r7 . t~',~ ,5~ , do hereby accept the appointment as
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Campaign Treasurer ~ Deputy Treasurer for the campaign of ~~ ~ (V i'p f.~ ,
who is seeking nomination or election as a /~Uj1 ~ ~i~` f q~_ candidate to the office of
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UND R PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
~ Date ~ Sig ature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 01/08) ~