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STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF'CAM'~AfGN DEPOSITORY
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CHECK APPROPRIATE BOX
fZl Original Appointmen~-
o Deputy Treasurer
o Reappointment of Tr~asursr
o Secondary Depository,.....
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1. Address (include post office box or street, city, state,ozip cod~) .....,
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J8ot'ef-- PO J3cx: -40:5'843 _JI E r:t 3~~ (;'
2. Party (Partisan candidates only) 3. Office (add district, circuit or group numbel)
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Name of Candidate
I have appointed the following person to act as my
W Campaign Treasurer
D Deputy Treasu'er
4. Name of Treasurer or Deputy Treasurer
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5. Mal 'ng Address (if post office box or drawer add street address)
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7. City
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8. County ""Ita,tlt'
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6. Telephone
Q(i;V<;:;1"3-:372 C
9. State
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10. Zip Code
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I have designated the following named bank as my
o Primary Depository
o Secondary Depe1sit )ry
11. Name of Bank
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12. Street Addr~
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13. City
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14. County
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I WILL NOTIFY YOU OF ANY ADDITIO S OR CHANGES TO THESE APPOINTMENTS.
17. Sign<;!~ure of Candida~
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16. Zip Ceode
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Date
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, Campaign Treasurer's Acceptance of Appointment
~t~C1.r€i:/,tt~tfbofl b . do hereby accept the appoin1mE nt as
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Q'Campaign Treasurer 0 Deputy Treasurer for the campaign of
who is seeking nomination or election as a
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candidate to the I)ffi ;e of
(Party)
As a duly registered voter in
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County, Florida, I am qualified to accept this appointment.
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Signature'Of Campa~gn Treasurer or Deputy TreasL reI
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Date
OS-DE 9 (Rev. 11/95)
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STATEMENT OF CANDIDATE ..,.'... : :.:~~Ir=
(Section 106.023, F.S.) ,.'1 ".c.,,:, ,; L.I I ut..
(PLEASE TYPE)
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candidate for the office of __Cl.-u L{C r
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have received, read and understand the requirements of Chapter 10Ei,
Florida Statutes.
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<'--Signature clCandidate
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Date
Each candidate must file a statement with the qualifying officer within 10
days after he files his Appointment of Campaign Treasurer and
Designation of Campaign Depository. Willful failure to file this form is a
first degree misdemeanor and a civil violation of the Campaign Financin~:J
Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c),
106.265(1), Florida Statutes).
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OS-DE 84 (Rev. 11/95)