DS DE 9 M. Shapiro
STATE OF FLORIDA OFFICE U Y
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APPOINTMENT OF CAMPAIGN TREASURER 2009
AND DESIGNATION OF CAMPAIGN
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DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) ,
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(PLEASE TYPE)
CHECK APPROPRIATE BOX:
Original Appointment ~ Deputy Treasurer ~ Reappointment of Treasurer ~ Secondary Depository
Name of Candidate 1. Address (inGude post office bo or stre t, city, state, zip code)
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Telephon optional)
3oS-1~~~ ~~'yy' 2. Party (Partisan candidates only) 3. Office (add district, circuit or group number
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I have appointed the following person to act as my Campaign Treasurer ~ Deputy Treasurer
4. Name of Treasurer r Deputy Treasurer
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5. Mailing Address (If post office box or drawer add street address)
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I have designated the following named bank as my Primary Depository Secondary Depository
11. Name of Bank
4ZEGrtol'¢s ~4A k 12. Street Address
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13. City
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17. Signature andida Date
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g reasurer's Acceptance of Appointment
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I. ~~~~~ ~ 9 (1 F~ ~ ~ , do hereby accept the appointment as
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Campaign Treasurer ~ Deputy Treasurer for the campaign of ~ ~ ~ ~~~~' ~y
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who is seeking nomination or election as a candidate to the office of
M /gyp t` A (Party)
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County, Florida, I am qualified to accept this appointment.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
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ate Signature of Campaign Treas r or Deputy Treasurer
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