Simon Cruz DS-DE9 Form
STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
OFFICE USE ONLY
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C!3 Original Appointment
Name of Candidate
...::5;; /Yl D A/ C re I,) L
o Deputy Treasurer
o Reappointment of Treasurer 0 Seco~ry ~OSi~
1. Address (include post office box or street, city, SThte, zip code)
/ ~-- 0 D 73 '7" j? o;.f lJ .# 9/</
J11 / 4#/ j1C::>-4,:<~ .-c~ .? 3' / :5 Y
Telephone (optional)
2. Party (Partisan candidates only)
3. Office (add district, circuit, group number)
/1/9 YO/-:C
I have appointed the following person to act as my
4. Name of Treasurer or Deputy Treasurer
M i ~ A, fi.-L s:: \AI It (L L- cF J(Z.'-\J ~:IY SC,~I wA-tLf~ :t ~~C-'/I1l-S CPA-'5
5. Mailing Address (If post office box or drawer add street address) 6. Telephone
':.LSl'-{ Hull wood ALvD S~ -605 q$.'1-ql2..-~eCCr
7. City 8. County B II" 0 u,.;n1r ~ 9. State 10. Zip Code
~\l " . Pc 302-0
. [8J Primary Depository D Secondary Depository
12. Street Address
l(1S<r gr
g] Campaign Treasurer
D Deputy Treasurer
I have designated the following named bank as my
11. Name of Bank
Co 1 ON." L ~f'Jt:..
13. City
f\..-lll\l"'-~ 3~
17. j(nature of Ca
14. County
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15. State
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16. Zip Code
3'3\'10
Date
- .2.7. 0 <:p
Campaign reasurer's Acceptance of Appointment
I, ("\. \ <:... 1..\ A f1:L .sc.r+..v<\ ~12....-. C ~ It: , do hereby accept the appointment as
(Please Print or Type)
5{j Campaign Treasurer D Deputy Treasurer for the campaign of
.:5 /,+/o..d CI(,;J~
who is seeking nomination or election as a
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. (Party)
candidate to the office of
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. As a duly registered voter in
11,411/' , lJ A..z> c;-
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.
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Date
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Signatu e of Campaign Treasurer or Deputy Treasurer
OS-DE 9 (Rev. 02/06)