DS-DE 9-1 Treasurer Hundley APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 2013 JAN —7 AN 10. 13
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) CITY CU rtn"'S
(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):
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) _ _
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4. Telephone 5. E-mail address VA 17 4m 4c--(4 �1. 3 31 3 g
L 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
I'V\ AYo� �� A"''` '� � -N ❑ 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 ,0 Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address 3 3t7 'f 12. Telephone
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13. 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
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21. City 22. County 23. State 24. Zip Code
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. Signature of Candidate
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27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, ► , do hereby accept the appointment
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(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
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Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.