DS-DE 9 STATE OF FLORIDA
A~,~I~t~"OF CAMPAIGN TREASURER
AND bESIGN.~,II~IN:QF CAMPAIGN DEPOSITORY
(PLEASE TYPE)
IName of Candidate
/ECK APPROPRIATE BOX
Original Appointment
[~ Deputy Treasurer
[] Reappomtment of Treasurer
[-'] Secondai'y Dep~i~o'~;r~
Address (include post office box or street, city,~'~,~te;~z~p
Telephone (optional) 2. Party (Partisan c~andidates only) I 3. Office (add district, circuit or group nuhlber)
I have appointed the following person to act as my ~"'~ampaign Treasurer U Deputy Treasurer
4. Name of Treasurer or Deputy Treasurer
5. Mailing Address (If post office box or drawer add street address)
I have designated the following named bank as my
6. Telephone
9. State I 10. Zip Code
Primary Depository I J Secondary Depository
11. Name of Bank
13. City
17. Signature of Candidate~P'~'~'~'~ ~l/~ '~,~1 Date
"/ Campaign Treasurer's Acceptance of Appointment
(Please Print or Type)
[ Ca~paign Treasurer [~ Deputy Treasurer for the campaign of
who is seeking nomination or election as a ,,Z.?~'.
(Pa~ty)
~ ~/,5'~,C~,,'~',,~'~=,,~ -- ~',~',,~ ~'(~'~.~As a d¥1y registered voter in
, do hereby accept the appointment as
candidale to the office of
County. Flodda, I am qualified to accept this appointment.
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 SignatUre of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 11/01)