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DS-DE 9-1 Jorge Expositoi � w _ o APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (Section 106.021(1), F.S.) T W (PLEASE PRINT OR TYPE) cr NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY 1. CHE K 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, ast) 3.Address(include post office box or street, city, state, zip - code) 0)03 fi,4Pr1q,1taW l/r� 4. Telephone 5. E-mail iddress ` 33)3� ('30-5 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if applicable: �K4 K �5 ©v, �� _ ❑ My intent is to run as a Write-In candidate. 8. If a candidate fora 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 11. Mailing Addres 12. Telephone /-�, 3 13. City 14. County, 15. State 16. Zip Code 17. E-mail address (awl 18. 1 have designated the following bank as my �rimary Depository ❑ Secondary Depository 19. Namq of Bank 20.Address�4. &?3(,0V7_5 Bcxlvt �21. City 22. County 23. State 24. Zip Code /if Al it?W 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 r7. Treasurer's Acceptance of Appo ment(f' in th "as and chec th appropriate block) r , ® / in 0 , do hereby accept the appointment (Please Prin or Type Name) designated above as: ❑ Campaign Treasurer Oe'OeDeputy Treasurer. //,/Z 3 X ate a re of Ca a n Treasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.