DS-DE 9 STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN DEPOSITORY
FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE TYPE)
Name of Candidate
Telephone (optional)
( )
2. Party (Partisan candidates only)
CHECK APPROPRIATE BOX
[] Original Appointment
[] Deputy Treasurer
[] Reappointment of Treasurer
[] Secondary Deposi.ory
1. Address (include post office box or street, city. ~,te, zip code)
I have appointed the following person to act as my
Office (add district, circuit or group number)
Campaign T~easurer
Deputy Treasurer
4. Name of Treasurer or Deputy Treasurer
7. City 8. County
I have designaled the following named bank as my
5. Mailing Address (if post office box or drawer add street address)
9. State
I [ Primary ]Depository
6. Telephone
10. Zip Code
I I Secondary Depository
11. Name of Bank
13. City
17. Signature of Candidate
14. County
12. Street Address
1,5. State
16. Zip Code
IDate
Campaign Treasurer's Acceptance of Appointment
[Please Ptir4 or Type)
I---'-I Cal~aign Treasurer I-'--'] Deputy Treasurer for the campaign of
who is seeking nomination or election as a
(Party)
· As a du. ly registered voter in
, do hereby accept the appointment as
candidate lo the office of
County, Florida. I am qualified Io 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
X
Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 11101)