DS-DE 9 Mark Samuelian 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. OFFICE USE ONLY
1.
X
CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: Treasurer/Deputy El Depository 0 Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last)
Mark George Samuelian
3. Address (include post office box or street, city, state, zip
1c8Venetian Way #1502
Miami Beach, FL 33139 4. Telephone
(305 , 915-4316 )
5. E-mail address
mark@marksamuelian.com
6. Office sought (include district, circuit, group number)
Miami Beach City Commission, Group 2
7. If a candidate for a nonpartisan office, check if
applicable:
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
Write-In No Party Affiliation Party candidate.
9. I have appointed the following person to act as my X Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Laura Dominguez
11. Mailing Address
10 Venetian Way #1502
12. Telephone
( 305) 915-4316
13. City
Miami Beach
14. County
Miami-Dade
15. State
FL
16. Zip Code
33139
17. E-mal address
Laura@marksamuelian.com
18. I have designated the following bank as my X Primary Depository Secondary Depository
19. Name of Bank
BankUnited
20. Address
1695 Alton Road
21. City
Miami Beach
22. County
Miami-Dade
23. State
FL
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
__S ,f //. /
26. Signature of Candidate ,-
,,-- _, - x _
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
Laura Dominguez
do hereby accept the appointment
designated above as:
,._.
( /7
(Please Print or Type Name)
X Campaign Treasurer Deputy Treasurer.
X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10)
Rule 1S-2.0001, F.A.C.