DS-DE 9 Robert C. Lansburgh 2017 t.', in. '.�. u l
; .; .. j
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 2017 J . t 7 PH 3: 42
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) C T Y (:I ;_,,,, 5 U F I= ICE
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. _ OFFICE USE ONLY
1.$ECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: El Treasurer/Deputy ® Depository El Office LJ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address (include post office box or street, city, state,zip
1 code)
11...0)014 c� rr��
C rc— t cl Gns V l- J I V n L -or.) P,01 0 THLI
4.Telephone 5. E-mail address f j 3 f 2 c/I
( 3os ) y7-7- Iz`)5 p,cLttne;-i (�I, ) L, . GOP's h IA!/1 (�CY� C ) I , > 1
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
C \ T '-'1 C Dr---r, 1 s 3 ) G g J ti P 2-, El 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
Ei Write-In El No Party Affiliation EI Party candidate.
9. I have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
P Q i2 r�.is ti S e,, P-0 f i.
11. Mailing Address 12. Telephone
13. City 14. County 15. State 16.Zip Code 17. E-mail address
•-r, i it-1 \ 0 A O c I- L 33x1`1 f?cL,r^ 5T 61-'1-iii I.. ,cG►'"1
18. I have designated the following bank as my El Primary Depository fl Secondary Depository
19. Name of Bank 20.Address
C 1 T.--\ t■) 4 i ; c,.N .n L-- lv r■
21. City 22. County 23. State 24. Zip Code
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UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING M FOR •r•POIN ENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT T FA ST•TED IN I ARE TRUE.
25. Date 26. Signatu of Candka
27. Treasurer's Acceptance of Appointment in the blanks an c'eck the appropriate block)
R_I, .0L e.%4 L cAn S 1 b v,- c� I , .o hereby accept the appointment
(Please rint or Type Name)
designated above as: Campaign Treasurer Depu Treasurer.
/ - / 7 -l "-) X
Date Signatu a of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.