DS-DE 9 CrystalSTATE OF FLORIDA OFFICE uSE ONLY
APPOINTMENT OF CAMPAIGN TREASURER ;? ~ ~ ° #.- ~ '~' , "~
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES Z ~ 4CT ~ 3 P I = 58
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
1. ECK APPROPRIATE BOX:
Original Appointment Change in: ^ Treasurer/Deputy ^ Depository ^ Office ^ Party
2. Name of Candidate (in this or er: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code) P
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4. Telephone (optional) 5. E-mail address (optional) /~ ~ 1 ~; U ~ 4C `~ ~~ ~~ ~'7
6. Office sought (include des rict, circuit, group number) 7. If a candidate for a non artisan office, check if
applicable:
~~
^ M In t i o s a Write-In candidate.
8. If a candidate fora artisan office, check to and fill in name of party as applicable: My intent is to run as a
® Write-In ^ No Party Affili n Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer ^ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Addres (If post office box or draw r, Iso include street ad ress)
1~.0. ~,x cj/6/s~/'Yt~Q-,; ,Oe~~, F~ 33~~,r~•
S6od Co111~.5 ~w~ 12. Telephone
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13. City
~~~ ~ 14. County
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~ 15. State
rL 16. Zip Code
3~~~~ 17. E-mail address (optional)
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18. I have designated the following bank as my Primary Depository ^ Secondary Depose ory
19. Name of Bank
~~~ 20. Street Addr s
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21. City
/`~i a 22. County
~ ~ 23. State t
r L 24. Zip Code
3~1 9
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
°` l~ ~ o% 26. Signatu of C a
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, AUe, ~/ A' , do hereby accept the a ointment
PP
(Please P in Type Name)
designated above as: 'Campaign Treasurer Dep reasu r.
a ~ a p! X
Date a of Campaign Treasurer or Deputy Treasurer
nc- n~ n ~~--- ........