DS-DE 9 & DS-DE 84 Forms
STATE OF FLORIDA OFFICE USE ONLY
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
0 Original Appointment 0 Deputy Treasurer 0 Reappointment of Treasurer 0 Secondary Depository
Name of Candidate 1. Address (include post office box or street, city, state, zip code)
Telephone (optional) 2. Party (Partisan candidates only) 3. Office (add district, circuit, group number)
( )
I have appointed the following person to act as my D Campaign Treasurer D Deputy Treasurer
4. Name of Treasurer or Deputy Treasurer
5. Mailing Address (If post office box or drawer add street address) 6. Telephone
7. City 8. County 9. State 10. Zip Code
I have designated the following named bank as my D Primary Depository D Secondary Depository
11. Name of Bank 12. Street Address
13. City 14. County 15. State 16. Zip Code
17. }('nature of Candidate Date
Campaign Treasurer's Acceptance of Appointment
I, ' do hereby accept the appointment as
(Please Print or Type)
D Campaign Treasurer D Deputy Treasurer for the campaign of ,
who is seeking nomination or election as a candidate to the office of
(Party)
. As a duly registered voter in
County, Florida, I am qualified to accept this appointment.
UNDER PENAL TIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
X
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 02/06)
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please Type)
I,
candidate for the office of
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
x
Date
Signature of Candidate
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes) .
OS-DE 84 (Rev. 08/03)