DS-DE 9 4 D. Crystal APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 2013 AUG _9 PM 12: 46
DEPOSITORY FOR CANDIDATES
(Section 106.021(1) F.S.) J 0 F
(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
_D(�U t code) AQ . &.\/ Lims
4. Telephone 5. E-mail address Mrs Vvoj &Cj, !"G _7'q
(3o'S )33a —Sa 9 Pvj, J�
6. Office sought(include district, circ it, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
❑ My intent is to run as a Write-In candidate.
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8. If a candidate for a partisan office,check block arid 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
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11. Mailing Address 12. Telephone
(v L, 3as )33o- Sag
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
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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 Candi
X
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, DI gut cvyj- a( , do hereby accept the appointment
(Please Print/or Type Name)
designated above s: ❑ Campaign Treasurer Deputy Tr rer.
Date Sign a of Campaign surer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.