DS-DE 9 OriginalSTATE OF FLORIDA OFFICE USE ONLY
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR
CANDIDATES
(Section 106.021(1), F.S.) ~ ; c
-°i O
(PLEASE TYPE) ._, L
CHECK APPROPRIATE BOX: "~~ r~-
w
.
Original Appointment Deputy Treasurer ~ Reappointment of Treasurer ~ Secondaf~, +, De~sitory
ame
N
of
Candidate 1. Address (include post office box or street, city, state, zip code)
,(
f
r
/
2 ~ -
~-~
[
Telephone (optional) 2. Party (Partisan candidates only) 3. Office (add district, circuit, group number)
( ) ,tip ~ ,,
f'~~1 .~ ~ C~ !2
I have appointed the following person to act as my ~ Campaign Treasurer Deputy Treasurer
4. Name of Treasurer or Deputy Treasurer //~~
5. Mailing Address (If post office box or drawer add street address) 6. Telephone
/
7. C
ity
Jvll~~~ .~t/~f-~ 8. County
i~t~.~~~i/ - ~~4L~ ~ 9. State
~~ 10. Zip Code
_? ~ i ~ ~%
I have designated the following named bank as my Primary Depository ~ Secondary Depository
11. Name of Bank ~
~~' , ~-c /(.1R try -tiA ~ ~j~ ~ ~ c> ~ ~ ~/~ . 12. Street Address
5i ~ ~ ~,~ f~~.e Ccc~~~ N. - 1FeQ
13. City ~ ~ 14. County/1 f j (~ 15. State// 16. Zip Code
17. Signature of Candidate
x Da
~ ~
Campaign Treasurer's Acceptance of Appointment
~
I. ~
t ~ ~ ~ ~~ ~ ~`~ ~~ C G 1 Gti ~' ~ ~ ~' <ti-- (
, do hereby accept the appointment as
(Please Print or Type)
Campaign Treasurer ~ Deputy Treasurer for the campaign of ~~ ~ ~ (~yt C/ : S ,y) ~ "' f
who is seeking nomination or a of ction as a ~ candidate to the office of
(Party)
it !~ s
/~ ~ ~ ~ ~' !~ As a duly registered voter in ~?~/~~G=~~f - ~~ ~ (~
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.
5
-7
ate gnatu~ f Campaig reasurer or Deputy Treasurer
a ~nvv. vcivo~
63