DS-DE 9-4 RedfernSTATE OF FLORIDA OFFICE USE ONLY
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APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN ~QQ9 $~~ j ~ ~~( IOC 34
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) ~,~ I ~{ (;~ ~~;~'; (Jh:~ ~(,f
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
Original Appointment Deputy Treasurer ~ Reappointment of Treasurer ~ Secondary Depository
Name of Candidat~ ~ ,
~~/~cl ~~ ~za//'V/ 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 (ad/damdistrict, circuit or group number)
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I have appointed the following person to act as my ~ Campaign Treasurer eputy Treasurer
4. Name Treasurer or puty Treas er
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5. Mailing Address (If post office box or drawer a d street address
l 6. Telephone
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7. Ci y 8. County
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I have designated the following named bank as my rimary Depository Secondary Depository
11. me of Bank 12. Street Address Q~~
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13. Cit ' 14. ounty ~ . S e 16. Zip Code
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17. Signature of andidate
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Campaign Treasurer's Acceptance of Appointment
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7=i•~ , do hereby accept the appointment as
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Campaign Treasurer Deputy Treasurer for the campaign of ~.(/~~/ ~~/Cz.I`~~ ,
who is seeking nomination or election as a ! `'1 ~~~ candidate to the office of
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As a duly registered voter in
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County, Florida, I am qualified to accept this appointment.
UNDER PENALTIES OF PERJURY, 1 DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
Date a r of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 08/03)