DS-DE 9 Levey APPOINTMENT OF CAMPAIGN TREASURER ,,-.
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 2011 SEP - 2 PM 4.
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
CITY CLERKS OFF ICE
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Er Initial Filing of Form Re- filing to Change: 0 Treasurer /Deputy El Depository Office El Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
...,ALA Kfl" RI VE12.0 LE VEX code)
4. Telephone 5. E -mail address `? ? 7 7 p liV E � t E ,
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
y C� 0 My intent is to run as a Write -In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
Q Write -In El No Party Affiliation Ei Party candidate.
9. I have appointed the following person to act as my ErCampaign Treasurer El Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
LEVE
11. Mailing Address 12. Telephone
6 Eg1 DMA/ /9 VE E r 0 0 ( 30 ') E: 72 - 5007
13. City 14. County 15. State 16. Zip Code 17. E -mail address
/3( /nifni f L 33i y / eve. /eve layW. Ccm
18. I have designated the following bank as my EV Primary Depository El Secondary Depository
19. Name of Bank � Uttt 20. Address
baLi l Ba � � /C s tz, /I•✓ Av tI
21. City 22. County 23. State 24. Zip Code
IAA 1141 t t ftc 14- t i+ vvt. 33139
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 26. Signature Candidate
cf l j r i
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appr• • riate block)
Lek of / S L e VC^ y , do hereby accept the appointment
P PPo
(Please Print or Type ame)
designated above as: Campaign Treasurer D De ty Treasure
2 ' /
Date Signature of ampaign Tre surer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.