DS-DE 9-2 SKRoberts APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 2013 AUG 22 PH 12= 24
(Section 106.021(1), F.S.).
CIT Y (J"L1Ei "S 0 F If-E
(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 ffice Parry
2. Name of Candidate(in this order: First, Middle, Last) 3. Address(include pos office box or street, city, state, zip
O5 ke,K.mi h/wPL+,o q-R obex�j- - code) �/0 ? i�/a/W 11?944
4. Telephone 5. E-mail address
(go r)9o.5--02o 3o ziktw.P-,y @ 9wcy l�o6c2 •�-cJm
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
r applicable:
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 E] 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
7i� <!5:�)&_a
11. Mailing Address 12. Telephone[ v
C.Png�rd 6`� i Sdvr f �f/1 Gt,l•�c! t �J�/IA4
13. City 14. County 15. State 16. Zip Code 17. E-mail address
9neA 4.c b"' /All yo
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank 20. Address ,
— 0-yow r— OA7— —,4 C&I 21. City 22. County 23. Stat97 24. Zip Code
3
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. Signa andidate
X
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, D ,e , do hereby accept the appointment
(Please Print or Type Name)
designated above as: �ampaign Treasurer Deputy Treasurer.
i,--.:La Opp/31 X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE-9(Rev. 10/10) Rule 1S-2.0001, F.A.C.
I
I