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DS-DE 9-1 Adrian Gonzalez 2017 APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (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 1. CHECK 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 Adrian Gonzalez code) 5000 Lakeview Drive 4. Telephone 5. E-mail address Miami Beach, FL 33140 ( TOT) 534-8736 agmb305 @gmail.com 6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if City Of Miami Beach Commissioner Group III applicable: 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 El Write-In ❑ No Party Affiliation ❑ Party candidate. 9. I have appointed the following person to act as my Campaign Treasurer © Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Adrian Gonzalez 11. Mailing Address 12. Telephone 1521 Alton Road, #112 ( 305 ) 534-8736 13. City 14. County 15. State 16. Zip Code 17. E-mail address Miami Beach Miami-Dade FL 33139 agmb305 @gmail.com 18. I have designated the following bank as my © Primary Depository ❑ Secondary Depository 19. Name of Bank 20.Address Sabadell United Bank 1501 Alton Road 21. City 22. County 23. State 24. Zip Code Miami Beach Miami-Dade FL 33139 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 ST TED IN IT ARE TRUE. 25. Date 26. Signature o %�TiT`date 1/25/17 X 27. Treasurer's Acceptance of Appointment(fill in the blanks 'n• - the appropriate block) Adrian Gonzalez , do hereby accept the appointment (Please Print or Type Name) designated above as: ❑ Campaign Treasurer © Deputy Treasurer. 1/25/17 X Date Signature o palgn Treasurer or Deputy Treasurer DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.