DS-DE 9 Joshua M. Levy 2017 APPOINTMENT OF CAMPAIGN TREASURER r ,; '
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 2011 JAN f 7 AN 9: 22
(Section 106.021(1), F.S.)
1-
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. _ OFFICE USE ONLY
1.SNIECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy D Depository p Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
code) .5 C 3 .3 At -6 4- y 2
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4. Telephone 5. E-mail address / At i A-AA i
(36s )? 9 `( - c'� 1 ( 3LL"7 Po14-'✓ fj cv A, -
6. Office sought(include district, circuit,group number) 7. If a candidate for a nonpartisan office,check if
/ 1 ^n}� (jZ�G IT ) applicable:frub V—A 0 O -� d� 1" ' `�y'-' 0 My intent is to run as a Write-In candidate.
8. If a candidate for a rtisan office, check block and fill in name of party as applicable: My intent is to run as a
D
Write-In No Party Affiliation D Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
A-n//t/ . /"A L C o / #/.
11. Mailing Address 12.Telephone
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13. City 14. County 15. State 16. Zip Code 17. E-mail address
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18. I have designated the following bank as my E Primary Depository D Secondary Depository
19. Name of Bank 20.Address n
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21. City 22. County 23. State 24. Lip 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. Dat 26. Signatur of Candidate
1`7 -4. 01? X (it ivy
27. Treasurer's Acceptance of Appointment(fill in the lanks and check the appropriate block)
I, ANA/ C - / -C o '.J P',.1 , do hereby accept the appointment
(Pleas Print or Type Name)
designated above as: Campaign Treasurer i Deputy Treasurer. vl
- it 1 er
� 1 ( 7 X q'
Date Signa ure of Campaign ç7CL'uA
easurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001,F.A.C.