DS-DE 9 Amended- Meruelo r �
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RE. CF
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) ZOu SEP -9 pm 2 .
3Q
(PLEASE PRINT OR TYPE) CITY CLE O F F I C E
NOTE: This form must be on file with the qualifying
officer before opening the campaign accoun #. 3. -_ , OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
0 Initial Filing of Form Re- filing to Change: IA Treasurer /Deputy Depository ❑ Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)
Maria. leru.etb 7 P;iv-i Or
4. Telephone 5. E -mail address
�' i�` i1O �1 "141 VV) l CI I i r 2eu FL 3 'A L
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
n i /PM / -... S/ 071 — Gle 0 My intent is to run as a Write -In candidate.
8. If a candidate for a partisan office, check block and fill in n e of party as applicable: My intent is to run as a
i
n Write -In ❑ No Party Affiliation ® Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer yl Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Mar A. Mer't'fo
11. Mailing Address 12. Telephone
57.2-7 PIM 7 € M , O -.) ./ Y i/1)
13. City 14. County 15. St to 16. Zip Code 17. E -mail address
I r� U Rad k-- -- 4J Je- P .5 ynfileruelo&Qaievin.
18. I have designated the following bank as my El Primary Depository 0 Secondary Depository
19. Name of Bank 20. Address
uoNes Aue
21. it
p y 22. County 23. State 24. Zip Code
1 Pliati betiejt M/a/PLi P :4.3/3
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 2 .. Si re of Candidate
g � � // X . fr/ ' . "l2
27. r easurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, Haiti gfraelo do hereb hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Treasurer Deputy Treasurer.
/ S )- /40 x ) .dt'
tr ki . "//ee
Date Signature o Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.