DS-DE 9 (Campaign Treasurer)
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:
m Original Appointment
Name of Candidate
D Deputy Treasurer
D Reappointment of Treasurer
o Secondary Depository
1'6d4;~oe Zs~?{;;;r streetJ!j';;e~' zip code)
/0/tlfY7r Be;;;: FI -::53/4/
2. Party (Partisan candidates only) 3. Office (add district, circuit, group number) I /'
C/7 (OHfltIJf/IYJ J3...6ff. V
I haye appointed the following person to act as my [}6Campaign Treasurer D Deputy Treasurer
4. Name ofR~Gr&<uty Tr;;6~Af1>tJ;J
5. Mailing Address (If PQst office box ~r drawer add street address)
62)-50 (oC{/n5 i7!1e.
8. c,;~;t~ C!. j~ ' 9. StateFL
~OGE~ A~)RE1M soN'
Telephone (optional)
6. Telephone
7,C!110m/
10. Zip Code
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I have designated the followi~g named bank as my
11. Narrn: ~f ~ank , ) li J
VJ /j 5 iJ /;J G/tJ N / -/t//CI
13.~ 14. County
D Primary Depository D Secondary Depository
12. Street Address
15. State
16. Zip Code
17. ~nature of Candi
Date
I,
Campaign Treasurer's Acceptance of Appointment
120 y~ 1l6i/'(/;rJSFh
(Please Print or Type)
~mpajgn Treasurer D Deputy Treasurer for the campaign of 2t::j.f?/l /lklYJs err-,
, do hereby accept the appointment as
who is seeking nomination or election as a q Ij"
\ . / . . ~vp V (Party) ,
.;1(/1 H/ /!!P1cJ/ C ly LC~IIJ!/Ih . As a duly registered voter in
County, Florida, I am qualified to accept this appointment
candidate to the office of
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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMP GN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED AR R E.
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, Signature of Campaign Treasurer or Deputy Treasurer
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I Date
DS-DE 9 (Rev. 02/06)