DS-DE Philip Levine - O
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN -Cum� s
DEPOSITORY FOR CANDIDATES _r7l I
(Section 106.021(1), F.S.) all
(PLEASE PRINT OR TYPE) ° n
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NOTE: This form must be on file with the qualifying t=a W
officer before opening the cam ai n account. OWICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
X❑ 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
PHILIP LEVINE code)
1425 North View Drive
4.Telephone 5. E-mail address Miami Beach, FL 33140
(305 ) 673-9500 philip @baron-corp.com
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
MAYOR OF MIAMI BEACH applicable:
❑ 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 ❑X Campaign Treasurer ® Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
SANFORD B. HORWITZ
11. Mailing Address 12.Telephone
4000 HOLLYWOOD BLVD. SUITE 215 SOUTH ( 305 ) 652-4255
13. City 14. County 15. State 16.Zip Code 17. E-mail address
HOLLYWOOD BROWARD FL 33021 sandy.horwitz @gskcpas.com
18. 1 have designated the following bank as my ❑X Primary Depository ® Secondary Depository
19. Name of Bank 20.Address
BRANCH BANKING AND TRUST CO. 1691 MICHIGAN AVE., STE 100
21. City 22. County 23. State 24. Zip Code
MIAMI BEACH MIAMI-DADE FLORIDA 33139
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMEJVT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED E.
25. Date 26. Signature of Cand�dat
03/05/2013 X
27. Treasurer's Acceptance of Appointment(fill in the blanks the appropriate block)
i
I, �+04 a4 1F• No Xtj do hereby accept the appointment
(Please Print or Type Name)
designated above as: X❑ Campaign Treasurer De uty Trea er.
03/05/2013 X ,
Date Sfgnature Ca aign Treasurer or De uty Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.