DS-DE 9 STAI E OF FLORIDA
APPOINTMENT OF CAMPAIGN 'TREASURER
AND DESIGNATION OF CAMPAIGN DEPOSlTOR,Y
FOR CANDIDATES
021(1) ......
(Section 106. , F.S.) .
CHECK APPROPRIATE BOX
[~ Original Appointment
[] Deputy Treasurer
[] Reappointment of Treasurer
[] Secondary Deposi;ory
(PLEASE TYPE)
Name of Candidate
2. Party (Partisan candidates only) Office (add district, circuit or group n,,iTsber)
Telephone (optional) [
I have appointed the following person to acl as my I 4 Campaign Treasurer
Address (include post office box or street, city, state, zip code)
Deputy Treasurer
4. Name of Treasurer or Dep~jty Treasurer
5. Mailing Address (If post office box or drawer add slreet address)
8. Counly 9. State
7. city
I have designated the following named bank as my
13. City /V~ 14. County
Signature of Candidate
10. Zip Code
Depository I I Secondary Depository
:. Street Address
,~. State Code
Date
ampaign Treasurer's Acceptance of Appointment
(Please Print or TYpe)
~ Can~paign Treasurer ~ Deputy Treasurer
who is seeking nomination or election as a
for the campaign of
(Parly)
As a dyty registered voter in
County. Flodda. I am qualified to accepl this appointment.
hereby accept lhe appointment as
/k~/~ candidate to the office of
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
Date big. ,,su, ~ ~,, ~.~m~~ Deputy Treasurer
DS-DE 9 (Rev. 11101)