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DS-DE 9 Group III Zachary M. Eisner 2017
APPOINTMENTOFCAMPAIGNTREASURER ANDDESIGNATIONOFCAMPAIGN DEPOSITORYFORCANDIDATES Section106.021(1), F.S.) PLEASEPRINTORTYPE) NOTE: Thisformmustbeonfilewiththequalifying officerbeforeopeningthecampaignaccount. OFFICEUSEONLY 1. CHECKAPPROPRIATEBOX(ES): InitialFilingofFormRe -filingtoChange: Treasurer/Deputy Depository 0 Office Party 2. NameofCandidate (inthisorder: First, Middle, Last) M4). Lrs ` 3. Address (includepostofficeboxorstreet, city, state, zip code) szr w iO ,t, S+ Ur:..,,.: 3re.c-. 1= c33 / i04. Telephone 786 ) ? 376i -r 5. E-mailaddress Z4cI<eIcy ..• G_-)yA4, I.tc_ 6. Officesought (includedistrict, circuit, groupnumber) c.,•4••••• 2SS°' 0,1 ` GC--- - i' - 7. Ifacandidateforanon • artisanoffice, checkif applicable: MyintentistorunasaWrite -Incandidate. 8. Ifacandidatefora •artisanoffice, checkblockandfillinnameofpartyasapplicable: Myintentistorunasa Write -In NoPartyAffiliation Party candidate. 9. Ihaveappointedthefollowingpersontoactasmy CampaignTreasurer DeputyTreasurer 10. NameofTreasurerorDeputyTreasurer 5-4iv - 11. MailingAddress 12. Telephone 13. City C-4.. -e 14. County 15. State s., 16. ZipCode 5:, 17. E-mailaddress c-. 18. Ihavedesignatedthefollowingbankasmy PrimaryDepository SecondaryDepository 19. NameofBank s 20. Address s 21. City 22. County_. 23. State c__ 24. ZjpCode UNDERPENALTIESOFPERJURY, IDECLARETHAT1HAVEREADTHEFOREGOINGFORMFORAPPOINTMENTOFCAMPAIGNTREASURERAND DESIGNATIONOFCAMPAIGNDEPOSITORYANDTHATTHEFACTSSTATEDINITARETRUE. 25. Date 147 /1" Zd / 26. SignatureofCandidate X 27. Treasurer'sAcceptanceofAppointment (fillintheblanksandchecktheappropriateblock) I, , doherebyaccepttheappointment PleasePrintorTypeName) designatedaboveas: CampaignTreasurer DeputyTreasurer. X Date SignatureofCampaignTreasurerorDeputyTreasurer DS -DE9 (Rev. 10/10) Rule1S-2.0001, F.A.C.