DS-DE 9-1 Appointment of Campaign Treasurer APPOINTMENT OF CAMPAIGN TREASURER R F` r `-
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 20I3 OCT 18 PM 5' 14
(Section 106.021(1), F.S.)
CITY Cy!l.��1-�"� OFFICE
(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 F] Depository Office Party
2. Name of Candidate(in this or er: First, Middle, Last) 1 Address(include post office 4.ox or street, city, state,zip
code) (.-�cZS - � l ( <f
4. Telephone 5. E-mail address cc. L�
(2_e*> ) y10 2-- 30 5Aj_C&
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
?_r-� 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 Er6ampaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
CL AA CXrr Le-
11. Mailing Address 12.Telephone
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
21. City 22. Count 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 Ca at
x
27. Treasurer's Acceptance of Appointment(fill in the bla s and check the appropriate block)
6L ��kr , do hereby accept the appointment
(Please Print or Type Name)
designated above as- Campaign Treasurer Deputy Treasurer.
3 x
Date Si ature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) ZZ Rule 1S-2.0001, F.A.C.