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DS-DE 9-1 Joshua M. Levy 2017 APPOINTMENT OF CAMPAIGN TREASURER e AND DESIGNATION OF CAMPAIGN 201]I;, 1 d 1 , DEPOSITORY FOR CANDIDATES H" 9: 22 (Section 106.021(1), F.S.) ): (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. OFFICE USE ONLY VECK APPROPRIATE BOX(ES): Initial Filing of Form Re-filing to Change: Treasurer/Deputy ❑ 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) x 3 j 3 , .6A y rcd Jb s )-4, L y � � 33i � o 4. Telephone 5. E-mail address /� �, ( 3of ) 7 I -c7"( - Lc as( f i �n �� L- +-�►1•' ��µ 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if applicable: h C;t y (o r U� P ❑ 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. I have appointed the following person to act as my ❑ Campaign Treasurer ©r Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer 11. Mailing Address 12. Telephone 3-b3 3 A/ a ( 3es ) 7 ' ( - o `ll 13. City / 14. County 15. State 16. Zip Code 17. E-mail address /"t � M 1�-tir� Ark. ) 33 ( 4 0 % Ps)w„✓ Q (r.-i x-i 18. I have designated the following bank as my "rimary Depository ❑ Secondary Depository 19. Name of Bank 20.Address / r . T QQ A 2 v_sT ArAi l , e-rk v R 21. City 22. County 23. State 24. Zip Code I•4 g c4; AAA - 10f-d F t 3 3 1 VD 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 of andidate I� l ?11 X 27. Treasurer's Acceptance of Appointment(fill in t e blanks and check the appropriate block) Sit ye' 1" 4--e y , do hereby accept the appointment (Please Print or Type Name) designated above as: ❑ Campaign Treasurer Deputy Tre surer. frzJr X Date Si nature of Campaign Treasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.