DS-DE 9 Amended Wolfson APPOINTMENT OF CAMPAIGN RECFIVFD
AND DESIGNATION OF CAMPAIGN 2011 SEP -9 PM 3: 30
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) CITY CLEWS OFFICE_
(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):
a Initial Filing of Form Re- filing to Change: J Treasurer /Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
Sin () 0 ,A code)
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4. Telephone 5. E -mail address Z1/1 ; Gt�/V� 1 ��e � I p C 3 3 r q(
(3o ) $ i'S (( i.0( .6 ,f, -icAr
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
C k 601,nln 0v) ✓0 up r applicable:
/ 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
D Write -In 0 No Party Affiliation ® Party candidate.
9. I have appointed the following person to act as my fl Campaign Treasurer 7E1 Deputy Treasurer
10. Name Treasur r or Deputy Tre
IMO w0\ .0
11. Mailing Address 12. Telephone
- ( )
13. City 1 ounty 15. State 16. Zip, Code 17. E -mail address ( -✓�
A M; CV"\', - � 3 ��{! " o W) s 7.,, emu.
18. I have designated the following bank as my [4 Primary Depository 0 Secondary Depository
1 19.parpe of Barlic / 20. Address
t. 4 0 /tain AAtti011\ tAA k3ct 6 k ' u.J 1 * Ivo/1,
21. City 22. unt 2 tate 24. Zip Code
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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 T FACTS STATED IN IT ARE TRUE.
25. Date I 26. Sign.' ure If Candidate
it 0 ......- 2012k
27. / _ Treasurer's Acceptance of Appointment (fill in t ranks and check the appropriate block)
I, ) 0 nGliki1 UA \ , do hereby accept the appointment
(Please Print or Type Name)
designated above as: E Campaign Treasurer 6._ 1 -puty Treasurer.
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6j 1 ` X 1 .1111r
Date 1 Signature of syrai Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.