DS-DE 9 Raphael Herman - Mayor
STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106..021(1), F.S.).
(PLEASE TYPE)
OFFlcR~~PtliiE D
2007 JAN /8 PH 3: 53
CITY CL -,,1./,
t ~n S OFFICE
CHECK APPROPRIATE BOX:
RA PHAc 1-
HERI1AA/
D Reappointment of Treasurer D Secondary Depository
1. Address (include post office box or street, city, state, zip code)
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I1/AHIIJEAe-H Z ~ 331l/-o
3. Office (add district, circuit, ~roup (lumber)
HA tJR. Dr It/AM BFi eN
~ Campaign Treasurer D Deputy Treasurer
E Original Appointment
Name of Candidate
D Deputy Treasurer
-
Telephone (optional) 2. Pl1rty (Partisan candidates only)
305i'7~ 'Sift __ ~.A.
I ha~e appointed the following Pf~rson to act as my
4. Name of Treasurer or Deplrt) Treasurer RAP H A E'L
HER.HA~
5. Mailing Address (If post office hox or drawer add street addressl
if IS 0 /V 1-'''- TI J-U-S; /) A I Y /?
7. City f 4 8. Courty. . 9. State t 10. Zip Code
)1/AH/ BFAe-H HI 1'11- OAf)F PL-P,Q.IOA 33/J./-O
I have designated the following named bank as my ~ Primary Depository D Secondary Depository
11. Name of Bank 12. Street Address
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16. Zip Code
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6. Telephone
A HTI<.USI BAA/k
13. City .. 14. County ,
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15. State
F t-CJ!l//)A
17. itnature of Candidate
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Ci'lmpaign Treasurer's Acceptance of Appointment
I.
RAPHAEL- /-IE/<HA~
(Please Print or Type)
, do hereby accept the appointment as
[}4 Campaign Treasurer
D Deputy Treasurer
for the campaign of
RAPHAEL IIE/<.NA,4/',
who Is seeking nomination or elecl.ion as a
.tV,A.
candidate to the office of
HAYPR.
,
. f ~~~
CJ F .!1/ A.I1I B?IJ.C II. As a duly registered voter in
I .
}1/AHt- /JAPG
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.
:JA/VIbAP-Y /8 , 20p 7
, DatI:! ;
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Sig ature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 02/06)