DS-DE 9 REn !VED
~.~
STATE OF FLORIDA e,"' ~'~ ~'f "J6
APPOINTME.T OF CAMPA,GN TREA t RI
AND DESIGNATION OF CAMPAIGN,~ ~::...~]F~'S OFF
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
OFFICE USE ONLY
(PLEASE TYPE)
__ECK APPROPRIATE BOX: ,
Original Appointment F'-] Deputy Treasurer [ J Reappointment of Treasurer [---I Secondary Depository
Name of Candidate I 1. Address (include post office box or street, city, state zip code)
mT. hon o pt,ona 0 2. Party (Partisan candidates o~,y, 3 Office (add district, circuit or gro n:m~e, ~
I have appointed the following person ,o act as my I qcampaign Treasurer I I Deputy Treasurer
4. Name of Treasurer or D~p..uty Treas~tr. er
5. Mailing Address (If post office box or drawer add street address)__. I 6. Telephone
I have designated the following named bank as my
11. Name of Bank
nature of Candidate
I9.,.State
J~.~Primary Depository
I ~..~Sc~te_Add ress .,~L
I
10. Zip Code
I I Secondary Depository
16. Zip Code
Date
~]~'Campaign Treasurer [~ Deputy Treasurer
who is seeking nomination or election as a
Campaign Treasurer's Acceptance of Appointment
(Please Pdnt or Type) [ -
for the campaign of ~~.~,
~,. C[~ C~vv~ (Party)
~¥Prt'~ ~ .-/ ~ ~5',{;),"-) e~~-'-'- . AS a duly registered voter in
'1
County, Florida, I am qualified to accept this appointment.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ TJ:IE FOREGOING CAMPAIGN TREASURER'S
uate -- "Si ' T~_~o~
~)aign or Dep
~ ,~/ gnature of Campaign T asur orDep tyT asurer
DS-DE 9 (Rev. 08/03)
. do hereby accept the appointment as
candidate to the office of
._