09- Form DS-DE 9 Rev 10/10APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.OFFICE USE ONLY
1.CHECK APPROPRIATE BOX(ES):
Initial Filing of FormRe-filing toChange:Treasurer/DeputyDepositoryOfficeParty
3. Address (include post office box or street, city, state, zip
2.Name of Candidate(in this order: First, Middle,Last)
code)
4. Telephone5. E-mail address
()
6.Office sought(include district, circuit, group number)7.If a candidate for anonpartisanoffice, check if
applicable:
My intent is torun as aWrite-Incandidate.
8.If a candidate for a partisanoffice, check block and fill in name of party as applicable:My intent is to run as a
Write-InNo Party AffiliationParty candidate
_________________________________________.
Campaign TreasurerDeputy Treasurer
9.I have appointed the following person to act as my
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address12. Telephone
()
13. City14. County15. State16. Zip Code17. E-mail address
Primary DepositorySecondary Depository
18.I have designated the followingbank as my
19. Name of Bank20.Address
21. City22. County23. State24. Zip Code
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. Date26. Signature ofCandidate
X
27.(fill in the blanks and check the appropriate block)
I,, do hereby accept the appointment
(Please Print or TypeName)
designated above as:Campaign Treasurer Deputy Treasurer.
X
DateSignature of Campaign Treasurer or Deputy Treasurer
Rule 1S-2.0001, F.A.C.
DS-DE 9 (Rev. 10/10)