DS-DE9 grp 6 STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN DEPOSITORY
Telephone (optional)
FOR CANDIDATES
(section 1 o6.021 (~). F.S.)
(PLEASE TYPE)
I have appointed the following person to act as my
4. Name of Treasurer or Deputy Treasurer
5. Mailing Address (if post office box or drawer add street address)
..l/o,, 1,
CHEC PPROPRIATE BOX
~inal Appointment
Deputy Treasurer
D Fieappointment of treasurer
T:
D
Secondary Deposit~/
,,,,:
1. Address (include post office box or street, city, stat~'F..~Zip
2. Party (Pertlean candidates only) 3. Office (add district, circuit or gro:~number)
dvp -vl
Campaign Treasurer D Deputy Treasurer
6. Telephone
9. Sta_,__te 10. Zip Code
I have designated the following named bank as my
11. Name of Bank
,~dmary Depository D Secondary Depository
12. Street Address
14. County 15. State I
I WILL NOTIFY YOU OF ANY ADDITIONS OR CHANGES TO THESE APPOINTMENTS.
~Campaign Treasurer D Deputy Treasurer for the campaign of
17. Si at of C~andidate ~/_/_ Date
X ' ~,~ ~.. ~_ ,-'~'---/.~> ';,.,/
~- Ca ~Jg Treasurer's Acceptance of Appointment
'. ./q / "~" 'C'(("~_~ ":)CII' )(' ()(' ~ .doherebyaccepttheappointmentas
(Please Pdm or Type)
(Party)
who iS seeking nomination or election as a
County, Florida, I am qualified to accept this appointment.
x.,..--
Date
candidate to the office of
/Signatr.~' 0~'Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 11/95)