DS-DE 9-1 Group III Zachary M. Eisner 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. CHECK APPROPRIATE BOX(ES):
❑ Initial Filing of Form Re- filing to Change: ® Treasurer /Deputy P Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
7 L)4 hit 7 11,,,,c ;sr�t.
3. Address (include post office box or street, city, state, zip
code)
4. Telephone
(7g6 ) 1c►®sy
5. E -mail address
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6. Office sought (include district, circuit, group number)
C,q,,, 0:,4 MA., Yee. c, Cam,,..; ss-4,, .
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 1 Campaign Treasurer ® Deputy Treasurer
10. Name of/Treasurer or Deputy Treasurer J-
11. Mailing Address
'77t /5;5e.7re. ,'4-e 5— /yca
12. Telephone
(-7g6. ) z(0 2317
13. City
ict'i...,.,•
14. County
l ;q.,: 1),.,P
15. State
7=
16. Zip Code
—37/5-7
17. E -ma'I address
A G4 (6.,•1~ e. In, vPc,p . c a a.,
18. I have designated the following bank as my XI Primary Depository ❑ Secondary Depository
19, Name of Bank
3g A/sr
20. Address
10 603 NW /2 `ti S' feel
21. City
"bo Ce,, /
22. County
MAA.,. Z:::).4.-4,'
23. State
F c.
24. Zip Code
3 3 / 7 Z.,
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
JL 6 ?0/7
26. Signature of Candidate
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
. 4° GL ) , do hereby accept the appointment
I, A 6(dA `
(Please Print or Type Name)
designated above as: 21 Campaign Treasure j
J,,,,,, G zo f 7 X
,
I Deputy Treasurer.
Date Signature of Campaign Trea r Deputy Treasurer
DS -DE 9 (Rev. 10/10)
Rule 1S- 2.0001, F.A.C.