DS-DE 9 AMENDED - Levey APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RECF1VF0
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) 2011 SEP -9 P!'1 2:23
(PLEASE PRINT OR TYPE) CITY CLBria'S OFFICE
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
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0 Initial Filing of Form Re- filing to Change: (i Treasurer /Deputy D e p ository El Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
(■(2_ � code)
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4. Telephone 5. E -mail address Gt . 5riv,,i, , F L 3 3 1 f 0
(3�) S31- ► a & Laura 62 VeY 1(061(1V-(1 C° 34/
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
PI aye e ( 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
D Write -In 21 No Party Affiliation J Party candidate.
9. I have appointed the following person to act as my E] Campaign Treasurer J Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11.
Mailing Address 12. Telephone
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13. City I f 14. County 15. State 16. Zip Code 17. E -mail address
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18. I have designated the following bank as my El Primary Depository El Secondary Depository
19. Name of Bank 20. Address
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21. City, 22. County 23. State 24. Zip Code
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UNDER PENALTIES OF PERJURY, 1 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. Signs of Candidate
9 - 4.- -- X if X k
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, ta t)a_ - (-al e y , do hereby accept the appointment
(Please PrinI or Type Name)
designated above as: 0 Campaign Treasurer Deputy Treasurer.
- / - 9 t I x Date Signature of Campaign Treasu er or Deputy reasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.