DS-DE 9-1 SKRobertsI
APPOINTMENT OF CAMPAIGN TREASURER " t- '., -
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES ZQ 3 AUG 2 f � �2' 13
(Section 106.021(1), F.S.)
CIT" CLEIRK OFF ICE
(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: zr Treasurer/Deputy C] Depository Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
code) o � /ed/.J
Ok" *(i4 PA A-1✓ 'Rob e-4T
4. Telephone 5. E-mail address S�e' a�
303�
(3®S') ao S--xO 30 Zk"" r 6
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:.
# l7YL A 1�aA " L ❑ 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 of Treasurer or DPnuty Treasure
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11. Mailing Address 12. Telephone
$//O r? d wcv lrj 'Raa-4l- oj",)orb.-'2,0��
13. City 14. County 15. tate 16. Zip Coe 17.E-mail addre s
ImIleA " ?a,�- 'W� - I ;;C�; eviegli,
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. a of Bank 20.Addres
[2 . City 22. County 23. S 24. Zip Code
Zvi � �
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 FACT TATED IN IT ARE TRUE.
25. Date 26. Signature d/Candidate
a
27. Treasurer's Acceptance of Appointment(fill in th nks and check the appropriate block)
I, eotrZ o y J 20�G4-,-f , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer Deputy Treasurer.
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X C__
Date ignatur of C&dpaign Treasurefr or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.