DS-DE 9 Libbin APPOINTMENT OF CAMPAIGN TREASURER c-) o
AND DESIGNATION OF CAMPAIGN r-%> �)o
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) C1
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(PLEASE PRINT OR TYPE) �-
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NOTE: This form must be on file with the qualifying � w �'I
officer before opening the campaign account. GPFI A US�;NLY
1. CH CK APPROPRIATE BOX(ES): Y,
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)
4. Telephone 5. E-mail address
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6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
❑ 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 Deputy Treasurer
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ll 1. Mailing Address 12. Telephone
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3. City 14. County 15. State 16. Zip Code 17. E-mail address
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18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20.Address
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
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27. Treasurer's Acceptance of Appointment(fill in a blanks and check the appropriate block)
I, J e,,02/Z �����;~� , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ❑ Deputy Treasurer.
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Date 50'ratureof eampaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.