DS-DE 9-1 FernandezSTATE OF FLORIDA o~~4~[';
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 209 SEP I I A~ 1 ~ ~ 12
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) ~; j j ~~' 1; L w~• i <: r', ~ ;i U i' ~- ~ (- f
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
^ Original Appointment Deputy Treasurer ^ Reappointment of Treasurer
Name of Candidate 1. Address (include post office box or street, city, state, zip code)
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Telephone (optional) 2. Party (Partisan candidates only) 3. Office (add district, circuit, group number)
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I have appointed the following person to act as my ^ Campaign Treasurer Deputy Treasurer
4. Name of Treasurer or Deputy Treasurer
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5.
Mailing Address (If post o
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ce 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 12. Street Address
13. C' y 14. County 15. S
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17. Signature of Candidate ,.
' Date
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Ca a' n Treasurer's Acceptance of Appointment
1, ~[~~ arc,.,. ~~ ~ , do hereby accept the appointment as
(Please Print or Type)
® Campaign Treasurer Deputy Treasurer for the campaign of ~~,Qy t"'.-~C~~~o .~ ,
who is seeking nomination or election as a ~ 5 candidate to the office of
(Party)
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UND R PENALTIES OF PERJ Y, I ECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
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Date Signatur f Campaig T surer or Deputy Treasurer
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