09 DS-DE 9 Appointment of Campaign Treasurer S. Roberts APPOINTMENT OF CAMPAIGN TREASURER �; _ 1 !j n
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 2012 MAR 21 PP1 1: 59
(Section 106.021(1), F.S.)
CITY CLEf%'K'S OFF 0
(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):
0 Initial Filing of Form Re-filing to Change: XQ Treasurer/Deputy 0 Depository Office E] Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state,zip
Sherry Roberts code)
100 Lincoln Road
4.Telephone 5. E-mail address Penthouse Two
(305 ) 205-2030 sherry@sherryroberts.com Miami Beach, FL 33139
6. Office sought(include district, circuit,group number) 7. If a candidate for a nonpartisan office, check if
Miami Beach Commissioner, Group 4 applicable:
❑ My intent is to run as a Write-In candidate.
8. If a candidate for a ap rtisan office, check block and fill in name of party as applicable: My intent is to run as a
Write-In E] No Party Affiliation Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Roberta Stephanie Gould
11. Mailing Address 12. Telephone
6586'Allison Road ( 305 ) 542-3839
13. City 14. County 15. State 16.Zip Code 17. E-mail address
Miami Beach Miami-Dade FL 33141 gould.r @ewm.com
18. I have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank 20.Address
Bank of America 1401 Lincoln Road
21. City 22. County 23. State 24.Zip Code
Miami Beach Miami-Dade FL 33139
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. Si gnat ,e of Candi
March 21, 2012
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
Roberta Stephanie Gould , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ® Deputy Treasurer.
March 21, 2012
Date Signature of Campaign Treasur or Deputy Treasurer