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)
.OK APPROPRIATE BOX:
riginalAppointment F'~ Deputy Treasurer
OFFICE USE ONLY
05 AUG 19 PHI2:09
~t~i' .,Lr ~,~'~ ~ OFFICE
FI Reappointment of Treasurer FI Secondary Depository
Name of Candidate I 1. Address (include post office box or street, city, state, zip code)
Telephone (optional) 2.
~, ,..~ I,~7I Party(Partisan candidates only,1'3' ~Office (add,.distdct, circuit or group number)
I have appointed the following person to act as my I'~/~ampaign Treasurer I I Deputy Treasurer
4. Name of Treasurer or..~Deputy Treasurer
5. Mailing ,~ddress (If post office box or drawer add street address)
7. City I 8. County /
I
I have designated the following named bank as my
11. Name of Bank
13. City , 14. County
17.
6. Telephone
9. State 10. Zip Code
~ Pdma~ Deposito~ ~ Sefonda~ Deposi,o~
15. State 16. Zip Code
Date
Campaign Treasurer's Acceptance of Appointment
(Please Print or Type)
~Campaign Treasurer E~ Deputy Treasurer
who is seeking nomination or election as a
, do hereby accept the appointment as
for the campaign of
(Party)
candidate to the office of
· As a duly registered voter in ~/'/~. ¢44,.,/ ,
County, Florida, I am qualified to 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.
'~-~' / ~-~ate~,,~ X~/s,gn~3Cd-re of Campaign ;i,~/~surer or Deputy Treasurer
DS-DE 9 (Rev. 08103)