Luis Salom DS-DE 9-2
STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
OFFICE USE ONLY
RECEIVED
2001 JAN I 6 PM 12= 08
CITY CLERK'S on ICE
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
D Original Appointment
Name of Candidate
[Z] Deputy Treasurer
D Reappointment of Treasurer D Secondary Depository
1. Address (include post office box or street, city, state, zip code)
Luis Salom
815 North Shore Drive
Telephone (optional)
305 868-8125
2. Party (Partisan candidates only)
3. Office (add district, circuit or group number)
Commission Group IV
D Campaign Treasurer [Z] Deputy Treasurer
I have appointed the following person to act as my
4. Name of Treasurer or Deputy Treasurer
Gloria Salom
5. Mailing Address (If post office box or drawer add street address)
815 North Shore Drive
7. City 8. County 9. State
Miami Beach Miami-Dade Florida
6. Telephone
305 868-8125
10. Zip Code
33141
I have designated the following named bank as my
11. Name of Bank
Bank United
13. City
Miami Beac .
14. County
.f Primary Depository Secondary Depository
12. Street Address
300 Arthur Godfrey Road
15. State
e
Florida
16. Zip Code
33140
Date
Campaign Treasurer's Acceptance of Appointment
I,
Gloria Sa 10m
(Please Print or Type)
o Campaign Treasurer [Z] Deputy Treasurer for the campaign of
, do hereby accept the appointment as
Luis Salom
who is seeking nomination or election as a
N/A
(Party)
candidate to the office of
Commission Group IV
. As a duly registered voter in
"'C','.-_.___
"
County, Florida, I am qualified to accept this appointment.
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE
ACCEPTANCE OF APPOINTMENT AND TH T
;/t(P/Of7 X
, Date
/;~~e~~GN TREASURER'S
.sTATED ARE TR)'E.
/
urer
DS-DE 9 (Rev. 08103)