DS-DE 9-1 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 opening the campaign account.
r
•
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
El Initial Filing of Form Re-filing to Change:
J Treasurer/Deputy q Depository q Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last)
Dan 1 t.d So 5+ l ts1 li
VI y‘
3. Address (include post office box or street, city, state, zip
code)
,a,,,,,, , p,,,,e, ciArt pao k
cel I y can) geact, fl 31 r l 4. Telephone
(3L47 )61A
- S % 55
5. E-mail address
DA rv7 & IC 0 txvICcf)4yo of• Coil
6. Office sought (include district, circuit, group number)
MA Yo k
7. If a candidate for a nonpartisan office, check if
applicable:
q 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
II Write-In Ei No Party Affiliation II Party candidate.
9. I have appointed the following person to act as my El Campaign Treasurer L,:j Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Ocolt.) kik,10.,
11. Mailing Address
a Okb Pro,tere. &Vt. -Pr30 I
12. Telephone
( 31)) 67).-Sg5T
13. City
Clif;" OCA.CA
14. County
Ncit-
15. State
-P i
16. Zip Code
33( 5 4
17. E-mail address
Po, hn1r5) Ko.t..rN yoye,Ccrri
18. I have designated the following bank as my Ej Primary Depository q Secondary Depository
19. Name of Bank
So Irt4
Ns+
20. Address
I I, C.5. lion Ca
21. City
en )(Xn-I. g eACt)
22. County
D444—
23. State
"F I
24. Zip Code
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 STATED IN IT ARE TRUE.
25. Date
L/9/ /7
26. Signature of Candidate
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I,
Do A Ic- I tat, yv , do hereby accept the appointment
designated above as:
9/7.l i
7
(Please Print or Type Name)
Il Campaign Treasurer ...,,
X 07
Deputy Treasurer.
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.