DS-DE9
STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER .
AND DESIGNATION OF CAMPAIGN DEPOSITORY
FOR CANDIDATES
(Section 106.021 (1), F .5.)
(PLEASE TYPE)
CH~sKAPPROPRIATE BOX
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Deput\l Treasufe~,.ffl,.,. r' ,',' .. 3' P 8
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ReappointmenlofTrea~ur~r ,. ~
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Secondary Depository
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Telephone (optional)
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2. Party (Partisan candidates only)
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3 Office (add district, circuit or group number)
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Name of Candidate
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I have appointed the following person to act as my
WCampaign Treasurer
o Deputy Treasurer
4, Name of Treasurer or Deputy Treasurer
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5. Mailing Address (if post office box or drawer add street address)
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6, Telephone
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7, City
8, County
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10 Zip Code
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I have designated the following named bank as my
BPrimary Depository
Secondary Depository
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11. Name of Bank
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13. City
12. Street Address
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14. County
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I WILL NOTIFY YOU OF ANY ADDITIONS OR CHANGES TO THESE APPOINTMENTS.
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Campaign Treasurer's Acceptance of Appointment
I, ~ yP'/ tJ ,t/ G K () L . do hereby accept the appointment as
(PleaSe Print or Type)
~ampaign Treasurer
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(Party)
who is seeking nomination or election as a
candidate to the office of
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G 1 ~. As a duly registere~voter in IZlt4p/ - 646C
County, Florida, I am qualified to accept this appointment
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Date
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Sig~ature of ~r or Deputy Treasurer
OS-DE 9 (Rev. 11/95)
,
STATEMENT OF CANDIDATE
(Section 106.023, F.S.)
(PLEASE TYPE)
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candidate for the office of (I()~,4l'j\/d#t::::?<!:
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have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Signature of Candidate
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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- fHe this form is a
first degree misdemeanor and a civil violation of the Campaign Financing
Act which may result in a fine of up to $1,000, (ss.~ 106.19(1 )(c),
106.265(1), Florida Statutes). .
OS-DE 84 (Rev. 11/95)