DS-DE 9 Mohammad R. Islam 201714. County
..1>e..ei
13. City •
-- N-01-014-4 - •
27, Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
, do hereby accept the appointment
Mot- -Amt-t-D Z , _TbL-Ativi
(Please Print or Type Name)
De Treasurer. Campaign Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.
19. Name of Bank 20. Address A
"-L '1-• ST gae-T
APPOINTMENT 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
office before opening the campaign account.
RE -
2611 MAY -6 PMis00
CITY CL.E.kA"'.'‘) OFFICE
OFFICE USE ONLY
[7] Depository Q Office Party
2, Name of Candidate (in this order: First, Middle, Last)
mot-AAmtle RAFtauL LLA-m
6. Office sought (include district, circt.0, group number)
C-01-1 PA r 551 01NY Goxsop 1"
3. Address (include post office box or street, city, state, zip
code)
1004) P,1arrii-3 >rive_
G.e_cA 3V4-1
7. If a candidate for a nonpartisan office, check if
applicable:
t.) El My intent is to run as a Write-In candidate.
4. Telephone
(41‘ )3C3-39-01-
5. E-mail address
hiolkAwvig-44,161..4 6b
U-162— YK.c....1 Low%
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 ti.),
p Write-In El No Party Affiliation 1:3 Party candidate.
9, I have appointed the following person to act as my Er Campaign Treasurer Deputy Treasurer
10, Name of Treasurer or Deputy Treasurer
MO tr‘Covo,$) (2-* taitAYY1
11. Mailing Address
.100,
4-0
voictyyl )r-3 iYa vi_
18. I have designated the following bank as my
15. State
Er-Primary Depository Secondary Depository
16. Zip Code
33141
17. E-ma I ad
4
41 ess
irn okokyym 12. 01"er, 1960
4 (en
21. City
Mk/Act-At
134011-
22. County
b 4-Da
23. State 24. Zip Code
3314 1
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
0 ar^S 2-011— .„
26. Signature oroan idate
X 411
designated above as:
0 S O IA 1—
Date
X -4-1 t
Signature of Campaign Treasurer or Deputy Treasurer
12. Telephone
(141 ) 3O2
ECK APPROPRIATE BOX(ES):
- Initial FilingFOrrn- -Re-filing to. Change: ED Treasurer/Deputy