DS-DE 9 L. Hundley APPOINTMENT OF CAMPAIGN TREASURER (" F I \ , F 0
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) 2d!2 OCT 2 9 PM � 0
(PLEASE PRINT OR TYPE) C!T.( °L L�'` "c) 0 F F I C
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. C CK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ❑ 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
code) 1 7 q3 Aglc H;jATt AV& 4PT-3
�.
4. Telephone 5. E-mail address. )NA 1 P.M, L�o 3 3 /3 9
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
0 4-- a-�,�"L e a clk ❑ 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
❑ Write-In ❑ 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 Depu Treasurer
L\ C1 \ �-1
11. Mailing Address \ ( 12. Telephone
13. City 14. County 15. State 16. Zip Code 17. E-mail address
M coo V-)eO, Co U00"r 3 a� .1 r\ t-k P�b e4 rn col 4 cd
18. 1 have designated the following bank as my DS Primary Depository ❑ Secondary Depository
19. Name of Bank 20.Address
—no (_c7,.L�4wtrw%u 3SO LIwCOLN 2oA �.
21. City 22. County 23. State 24. Zip Code
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 of Candidate
C)- X L
27. Treasurer's jAcceptanc_ ppointment (fill in the blanks and check the appropriate block)
I, ! f-- vi VX o hereby accept the appointment
(Please Prin r Type me)
designated above as: Campaign easurer ❑ Deputy Treasurer.
L�E� I �<:) `� X lmm=a
Date oLr ig ture of Campaign treasurer or Deputy Tr asurer
DS-DE 9 (Rev. 11 0110) Rue 1S-2.0001, F.A.C.