DS-DE 9 Adrian Gonzalez 2017 APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN `
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) 2017 AN 25 d;i i 8' 36 \ \
(PLEASE PRINT OR TYPE) r .
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
W HECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: El Treasurer/Deputy ® Depository D Office 0 Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)
4. Telephone 5. E-mail address
33®140
('io ) .���(o Prr nk%3oc @C#01,1L .Co'-,
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
(j 1144 I; ((vrhl^11 SSiS(t ( ,,p I \ 1 [] My intent is to run as a Write-In candidate.
8. If a/candidate for a partisan office, check block na d 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 fl Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
KCiel 1z, )2oseit «4
11. Mailing Address 12. Telephone
700 t4 jcr4 S-Vro¢ �' Ikt)X (303 el ) 32I --3--1
13. City 14. County 15. State 16. Zip Code 17. E-mail address
MIG�.1 NIIG..; —101.,1c FL 33137 Kenn)scn7.r 6 &ern, (.c(2.a
18. I have designated the following bank as my 'P Primary Depository Secondary Depository
19. Name of Bank 20. Address
44)PrCtQA v N A-t.c� i3 c ►So► 61 17--*O
21. City 22. County 23. State 24. Zip Code
\ 3)-Q1P V rr ■% - 40e - 7C 3 3 13'5
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 D IN IT ARE TRUE.
25. Date 26. Signature of ' ..
2c/ 17
X ,.
27. Treasurer's Acceptance of Appointment (fill in the blanks a check the appropriate block)
I<<n^Ch ( Se' LOA , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 0 Campaign Treasurer ❑ Deputy Treasurer.
I -- 2 6-- , ) X 144,, c eA,
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.