DS-DE 9 STATE OF FLORIDA RECEIVe' [~ CHECK APPROPRIATE BOX
APPOINTMENT OF CAMPAIGN TREA R I ~,M 10: I ~ OriginalAppointment
AND DESIGNATION OF CAMPAIGN DEI~Y~R~ Deputy Treasurer
FOR CANDIDATES CITY CLERICS 0FFI~ Reappointmentofmmasumr
(Section 106.021(1), F.S.) ~ Se~nda~ Deposito~
(PL~SE ~PE)
Name of Candidate 1. Address (in~ude POAt office box or street, city, state, zip ~de)
Telephone (optional) 2. Pa~y (Pa~isan candidates only) ~ 3. ~ce (add dist~,~ircuit or group nu~
I have appointed the following pemon to act as my ~ Campaign Treasurer I I~pu~ Treasurer
4. Name of Treasurer or Deputy Treasurer :..[~c~../~ ~
5. Mailing Address (If post~offic~e box.or drawer add street address)
City ~)~9.~ ~L~,~:-~ 9. State ¢~,~
have designated the following named bank as my
11. Name of Bank ~ ~~
14. C~nty ,
6. Telephon~ ~_ ~.
10.7ip Code
Primary Depository I I Secondary Depository
13. CityC~/V~ l , ~ ~ ~.( 15. State ~ 16. Zip Code
17. Signature of Candidate Date
Campa~ign Treasurer's Acceptance of Appointment
· ,. , do hereby accept the appointment as
(Please Print or Type)
'[~] Campaign Treasurer [~ Deputy Treasurer for the campaign of
who is seeking nomination or election as a
~;'~; ~(' ^ ~(.~.. (.~,~,~"~t~/1 . As a duly registered voter in
County, Florida, 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 AI~'~_ UE. ~ //
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 11101)