DS-DE 9 Góngora C: N
D
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN c-, M
DEPOSITORY FOR CANDIDATES r— ca
(Section 106.021(1), F.S.) 'T1
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying �, w
officer before opening the campaign account. OFFICE USE ONLY
1. CH 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, Last) 3.Address(include post office box or street, city, state, zip
M C1 � C��,S-�1G✓1 �'�{� �(� code) 1%30 (:�b(I,V-,S Ave . $
4. Telephone 5. E-mail address ��,rc�v►� Ge c(, `F- 33)`t'0
i
6. Office sought(include district, circuit, group number) 7. If a candidate fora nonpartisan office, check if
applicable:
o�� Cl ° iGlwl�� � ❑ 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 o reasur or Deputy Treasurer
f 4,e 1 6400; r
11. Mailing Address 12. Telephone
13. City 14. County 15. State 16. Zip Code 17. E-mail address
H ;� tAIC--"I -1�6e .fL, 33 ►�-tO w►�L&Y&e,(LnA'�Y-e( avj �G,
18. 1 have designated the following bank as my Eg-Primary Depository ❑ Secondary Depository
19. Name of Bank A 20. Address
9q"njK 160F2
21. City 22. County (� 23. State 24. Zip Code
K3139
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.
125. Date 26. Signature of Candidate
X
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, M �C7 0 , do hereby accept t the appointment
Pp
(Please Print or Type Name)
designated above as: Campaign Treasurer I T "Deputy Treas r
1
X f
Date Signature of Campaign Treasurg or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.