DS-DE 9 Michael Gongora 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
affleer before o•enin• the cams •n account.
p ,;
.. °
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
I► Initial Filing of Form Re- filing to Change: d Treasurer /Deputy ( Depository EJ Office EJ Party
2. Name of Candidate (in this order: First, Middle, Last)
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3. Address (include post office box�or street, city,
—
'/
state, zip
4. Telephone
(. 5" ) 26o -JvJ`i
5. E -mail address
roc eels + 6 o,�v'a,c w
�" I ! 33111°0
6. Office sought (include district, circuit, group number)
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M'4,i�.l e I HIV 6rpop
7. If a candidate for a nonpartisan office, check if
applicable.
El My intent is to run as a Write-1n 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 E No Party Affiliation [ Party candidate.
9. I have appointed the following person to act as my 0 Campaign Treasurer EJ Deputy Treasurer
10. Name of Treasurer or Depu Treasurer
i G a e i 'f6av cA
11. Mailing Address
eg8 0011 - :
12. Telephone
(3 )2 ._ )01 '`./
13. City
Mi 401 ! .a e.6-.)
18. I have designated the following
14. County
,/ ieiek;— � 2m
bank as my
15. State
FL
j Primary
16, Zip Code
331 V-�7
Depository
17. E-mal address
vn.c 1ei/nrr el con
f Secondary Depository
r «4, vw
19. Nape of Bank
b dc// ( '
20. Address
1S-0I ft/11)11 ka .
21.
UNDER
City
ca ea eA
PENALTIES OF PERJURY, I DECLARE
DESIGNATION
22. ounty
OM -- , de,
THAT I HAVE READ THE FOREGOING
OF CAMPAIGN DEPOSITORY AND THAT
23. State
:or1 dCt.
FORM FOR APPOINTMENT OF CAMPAIGN
THE FACTS STATED IN IT ARE TRUE,
24. Zip Code
331 3
TREASURER AND
26, Date
27,
i,
Treasurer's
` ' \A6
Moe nee of Appointment
( ()ill D( A
26, Signature of , Candldat-
...,r
(fill In the blanks and check the appro.�I block)
, do hereby accept the appointment
(Please Print o pe Name)
designated above as: id Campaign Treasurer fJ Deputy Treas irer.
2 13i lJ I�
"Dot Si nature of Cam ai n Treas ; - or De ut Treasurer
g p g l� p Y
S-DE 9 (Rev. 10/10)
Rule
I »2',0001, F.A.C.