DS-DE 9 Kenneth Bereski 2017RECEtV~:D
APPOINTMENT OF CAMPAIGN TREASURER 2017 JUL 27 PH 3: 46 AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES CITt Or MIAMI HEA£H
(Section 106.021 (1 ), F .S.)
OFP'IC OF THE CITY C f!J'(K
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
-1-.:-CHEClrAPPROPRIATE-BOX(ES):
181 Initial Filing of Form Re-filing to Change: 0 Treasurer/Deputy D Depository
D Office
D Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
Kenneth R Bereski II code)
PO Box 190841
4. Telephone 5. E-mail address Miami Beach, FL 33119
(786 ) 5054536 KenB@voteBereski.com
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
Mayor applicable:
D 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
D Write-In
D No Party Affiliation
D Party candidate.
9. I have appointed the following person to act as my
rZ1 Campaign Treasurer
D Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Kenneth R. Bereski II
11. Mailing Address 12. Telephone
PO Box 190841 ( 786 ) 5054536
13. City 14. County 15. State 16. Zip Code 17. E-mail address
Miami Beach Dade FL 33119 KenB@voteBereski.com
18. I have designated the following bank as my
jg! Primary Depository
D Secondary Depository
19. Name of Bank 20. Address
GTE Financial PO Box 172599
21. City 22. County 23. State 24. Zip Code
Tampa Hillsborough FL 33672
UNDER PENAL TIES 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 ;· sl{;~~d~ 2rJ ~ 7/27/17
27.
Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, Kenneth R. Bereski II , do hereby accept the appointment
(Please Print or Type Name)
designated above as:
(8)
Campaign T~sure%~ ~uty r:i ~
7/27/17
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.