DS-DE 9(1) RHerman c-
APPOINTMENT OF CAMPAIGN TREASURER ; �
AND DESIGNATION OF CAMPAIGN _
DEPOSITORY FOR CANDIDATES = `n
(Section 106.021(1), F.S.) "' V nr
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
offi er before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES): l
Al.� Initial Filing of Form Re-filing to Change:X Treasurer/Deputy Depository Office [j Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address (include post office box or street, city, state, zip
A PA� R1q A code)E q
4. Telephone 5. E-mail address ��/ �
( 3 7-el 9-5- 1 AM J Fi5.ACII )e::Z0�210A 33l�o
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
p applicable:
M yo ®,0 g /mil IA/&f1 $ c 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
9A PHA �-
11. Mailing Address 12. Telephone )M4x
(3as ) 67,54e?5e
13. City 14. County 15. State 16. Zip Code 17. E-mail address
18. I have designated the following bank as my .Primary Depository ® Secondary Depository
19. Name of Bank 20.Address
Sun/ TimUS 7- 9AAOC
21. City 22. County 23. State 24. Zip Code
SAL- HAR ROvRL I IVIAI-141 PARE FLoR_)PA 3315*
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
X g CV2XaAi,:e
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, �' PYA e5_Z— /1jC-_9 I'M , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer ® Deputy Treasurer.
07 13 x .
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.