DS-DE 9 Bower Deputy Treasurer APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 2010 NOV 19 kill: 38
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) CITY CLERKS OFF ICE
(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):
n Initial Filing of Form Re- filing to Change: 0 Treasurer /Deputy 0 Depository ❑ Office ❑ Party
2. Name of Candid to (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
MO _,
• iel W®Y/eA code)/i49497
4
' , A/ / afie--
. Telephone 5. E -mail address •
(„A9 AN. , � 33/39
6. Office sought (include district, circuit, group number) 7. If a candidate for a non 'san office, check if
applicable:
/Y 6 0 My intent is o ga Write -In candidate.
8. If a candidate for a partisan office, check block and fi i ame of party as applicable: My intent is to run as a
•' Write -In 0 No Party Affiliation EII /0 Party candidate.
9. 1 have appointed the following person to act as my - Campaign Treasurer �! Depu Treasurer
10. Name of Trea rer or Deputy Treas r
A7 /I �.l'ReR/9 ou/g/2
11. Mailing Address 12. Telephone
iliVA S ( )
1 J. City 2 14. County 15. State 16. Zip Code 17., -mail address
M../. .2 p
1/. 33/39 31,1214#1,404.1_46,) d
18. I have designated the following bank as my g Primary Depository 0 Secondary Depository
19. Name of Bank 20. Addres .
--OlasAteledillAS- 4 j ligifi 21. C y 22. unty 23. S to 24. Zip Code
/ 2 7 z S e. 33 /39
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 i j 2 . Signature of Candidate
HfiaZfr a X ', �.�
27. Treasurer's Acceptance of Appointment (fill in th lanks and check the appropriate block)
I , Ml kg 4 )3 9 LLA2. , do hereby accept the appointment
Please Type ( Print or YP Name)
designated above as: p Campaign Treasurer 'j Deputy Treasurer.
, NA00, /
Date S' x`--27i2,2te.4_„,,R/1.41144,
ature of Campaign Treasure or D - puty reasurer
DS -DE 9 (Rev. 10110) Rule 1S- 2.0001, F.A.C.