DS-DE 9 STATE OF FLORIDA
~/~~'~)OF CAMPAIGN TREASURER
AND DE$~qN~IgI~F CAMPAIGN DEPOSITORY
B~ ~"'~ '4_1~ .... FnO~[~,t~..N DiDATEs
_,~,,~ C'~ ~t~ 'O(,~c'tibn 106.021(1), F.S.)
(PLEASE TYPE)
CHECK APPROPRIATE BOX
Original Appointment
] Deputy Treasurer
] Reappointment of Treasurer
[] Secondary DeposLory
Name of Candidate I 1. Address (include post office box or street, city, state, zip code)
Telephone (opti(~nal) ' 2. Partly (P~a,[t~n candidates only) ~lt-"l- r~'i3'.T. O'~h~;~a~ 'e~st~'ict' circuit °r g r°up number) -'~
I have appointed the following person to act as my ampaign Treasurer Deputy Treasurer
5. Mailing Aqldr. ess (If post of~e box or dra~'r ~d.d stre~ddress)
I have designated the following named bank as my Primary 'Depository
Secondary Depository
11. l',J, eme pf Bank -- 1~ Street Address
13 · y 14. ounty . 15. Sta'- ~ ' Zip Code
17. Signature of C~i~Jte ~ Z /
g n Treasurer's Acceptance of Appointment
I, ~~ ~ ~P~n~ );~ , do here,y accept the appointme,' as
for the campaign of~
[ Can';paign Treasurer E~ Deputy Treasurer
who is seeking nomination or election as a ~ (P~any)
~ r~ 1 ,~,~.2-'~/'~./~ . Asa d.ul, registered voter in
County, Flodda. I am qualified to accept this appointment.
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~~~
- I I Date ~/ ~ ' g r~u~,~¢ ~f~¢~fpaign Treasurer
or Deputy Treasurer
DS-DE 9 (Rev. 11101)