DS-DE 9 Daniel Kahn 2017APPOINTMENT 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 o. enin ! the cam al. n account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
[B' Initial Filing of Form Re- filing to Change: Treasurer /Deputy [J Depository Q Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last)
L¢Ir)K L J J5i-t Y /ON�/V
3. Address (include post office box or street, city, state, zip
code)
()OM Q(� I Or— V� )
I NI i Rene, / 'I 331'5 q
4. Telephone
(3z,) a.
5. E -mail address
goroyfaNYCtPA- `11 "?'`'')
6. Office sought (include district, circuit, group number)
Oa Yo S Elf Pm; &e A c-ir,
7. If a candidate for a nonpartisan office, check if
applicable:
® My intent is to run as a Write -In candidate.
8.1f a candidate for a arm tisan office, check block and fill in name of party as applicable: My intent is to run as a
® Write -In No Party Affiliation ® Party candidate.
9. 1 have appointed the following person to act as my "Campaign Treasurer ® Deputy Treasurer
10. Name of Treasurer .r Deputy
o'l;eI MVO
Treasurer
t
11. Mailing Address
.3S0/ 75er 4uQ
/<
12. Telephone
(7gC ) ,:5 q
13. ity
1 l O
14. County
Brocve,C
15. tate
t...
16. Zip Code
530 6 (
17 E a . •dress
v ,, eVe 9e, ((`frei,
18.1 h . ve designated the following bank as my E Primary Depository E Secondary Depository
19. Name of Bank
��
5y�-IrUS �'
20. Address
)6c, 5 (1--tdv► Cg
21. City
MIDI Qe,o,d,
22. County
Dtl .D
23, State
.r1
24. Zip Code
8a)3�
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25. Date
q l 7/7 7
26. Sigpra re of C. • date
X ( r- �,
27. Trea ur is Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, 7) , e) I 4 V` , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer J - •u/ easurer.
C71/0 7 X I
Date Sign. ■ : • Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S- 2.0001, F.A.C.