DS-DE 9
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STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)'
, _, OFf.JC~ USE ONLY
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05 Jt!L25 PH3:58
~,1 T 'r C L r.~ 's .::;: r I'CE
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
~ Original Appointment
Name of Candidate
o Deputy Treasurer
D Reappointment of Treasurer
o Secondary Depository
1, Address (include post office box or street, city, state, zip code)
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Telephone (optional) 2. Party (Part.is}ln 'candidates only) 3. Office (add district, circuit, group number) .
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I ha~e appointed the following person to act as my ~ Campaign Treasurer D Deputy Treasurer
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 8. County
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9. State
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6. Telephone
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10. Zip Code
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I have designated the following named bank as my
11. Name of Bank
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13. City\JV\. t1
121 Primary Depository D Secondary Depository
12, Street Address
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14. County
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15, State
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16, Zip Code
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17. ~$lnatu e of Candidate
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Campaign Treasurer's Acceptance of Appointment
S -r -t'\ ,Z Q , do hereby accept the appointment as
(Please Print or Type)
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.~ Campaign Treasurer Deputy Treasurer for the campaign of --\-\J DC .~ ' :~ ~)~_
who is seeking nomination or election as a ~( :--..;f C ......J \) { 'F'\- candidate to the office of
~ " (Part~
~""-\\\'\\.)5\\h\J</J- G nov f> (' V,) . As a duly registered vo~er in 'M \ '1' IV\'\ . \::) R-O f::.
County, Florida, I am qualified to accept this appointment.
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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 Signature Of/~p~ign Treasurer or Deputy Treasurer
OS-DE 9 (Rev. 02/06)