DS-DE 9 Kristen Rosen Gonzalez APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 'a° F° _° '_
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) 2015M M - 1 FM I® I 0
(PLEASE PRINT OR TYPE) c; 'r' t h�. w..
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. C ECIC APPROPRIATE BOX(ES):
itial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. N me of Cand- to(in this order: First, Middle, Last) 3. Address(include post office box or street, city, state, zip
code) 4{0
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4. Telephone 5. E-mail address
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6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
it (NI applicable:
)\it? i .. a( ,1„ Jo In ry '�T 1 0 ® My intent is to run as a Write-In candidate.
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8. If a candidate for a partisan office, check block and fill ' name of party as applicable: My intent is to run as a
Write-In ❑ No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my6ampaign Treasurer 0 Deputy Treasurer
10. Name of Treasur r or Deputy Treasu
b --("an 0� za e7
11. Mailing Address 12. Telephone
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13. City 14. County 15. a 16. Zip Code 17. E-mail address
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18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 1\I°Cho 20. Address
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21. City 22. qounty • 23. State 24. Zip Code
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UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING M FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT • FAC- STATED IN IT ARE TRUE.
25. Date 26. S ignat re • Ca •idate
I X
27. Tr- s rer's A •tance of p ointment(fill in the bla• , and check the appropriate block)
I, s,-Y1'! ■ P - ' ci/\ �. , do hereby accept the appointment
(Plea.e 'rint or 'ype ame) ,-""e designated above as: Campaign Treasurer ® • putty re�urer.
1 i 1 c r \ 1 X I
D o to Signature Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.