DS-DE 9 Amended Simon Cruz
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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CHECK APPROPRIATE BOX:
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D Original Appointment
G3l Deputy Treasurer
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D Reappointment of Treasurer D Secon~a;ry ~ository
1. Address (include post office box or street, city, state, zip code)
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Name of Candidate
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Telephone (optional)
2. Party (Partisan candidates only)
3. Office (add district, circuit, group number)
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I have appointed the following person to act as my
4. Name of Treasurer or Deputy Treasurer
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5. Mailing Address (If post office box or drawer add street address)
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7. City
DC
D Campaign Treasurer
[Xl Deputy Treasurer
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6. Telephone
I have designated the following named bank as my
11. Name of Bank
LDD
13. City
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14. County I
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-----Campaign Treasurer's Acceptance of Appointment
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D Primary Depository 0 Secondary Depository
12. Street Address ~" '
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(Please Print or Type)
, do hereby accept the appointment as
D Campaign Treasurer [] Deputy Treasurer for the campaign of ;) t m~ n LA LtL
who is seeking nomination or election as a fi I ~ candidate to the office of
/ (Party)
.A1 aAj6Y . As a d,', ",g;ste,ed vote' '" ~ iafnl '. J)a citJ
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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t Date
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Signature of Campaign Treasurer or Deputy Treasurer
OS-DE 9 (Rev. 02/06)