DS-DE 9STATE OF FLORIDA
DE~ ~)5Lf~RVy
AND DESIGNATION OF CAMPAIGN
FOR CANDIDATES 03 M,~9 -b, PM 2:00
(Section 106.021(1), F,S.)
CITY CLERK'S OFFICE
(PLEASE TYPE)
CH BOX
Original Appointment
] Deputy Treasurer
[] Reappointment of Treasurer
[] Secondary Deposi,ory
Name of Candidate 1. Address (include post office box or street, city, state, zip code)
Telephone (optional) I 2. Party (Partisan candidates only) 3. Office (add di~slricl, circuil or group number)
(~ ~') ~'-]3-bo~-I Co(~ta~;~o~O G~ouP
4. Name of Treasurer or Deputy Treasurer
SyL.,ue~' tek' I..U~.c \ 5
5. Mailing Address (If post office box or drawer add slreet address.)
7. City 8. County I 9. State
I have designaled the following named bank as my ~ Primary 'Deposilory
6. Telephone
I10. Zip Code
7317i
'--'l Secondary Depository
11. Name of Bank
12. Street Address
1.5. State
13. City, I 14. County I
16. Zip Code
~.~/Campaign Treasurer's Acceptance of Appointment
[~Carl~aign Treasurer
(Please Print or Type)
r'-'l Deputy Treasurer for the campaign of
, do hereby accept the appointment as
who is seeking nomination or election as a
(Party)
· As a d¥1y registered voter in [.,~x I ~ t
candidale lo the office of
County. Flonda. I am qualified Io accepl this appointment.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FI~EGOING CAMPAIGN
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STAT~IE' //~
DS-DE 9 (Rev. 11/01)
TREASURER'S
/Si,~ta~e bf Ga~mp~,ign Treasurer or Deputy Treasurer