DS-DE 9 (1)STATE OF FLORIDA OFFICE USE ONLY
APPOINTMENT OF CAMPAIGN TREASURER ~ ~' ~: ~ 9 ~! ~' r)
AND DESIGNATION OF CAMPAIGN
Z~~j SAP 'I
DEPOSITORY FOR CANDIDATES
+ PM I2~ 36
(Section 106.021(1), F.S.)
CITY CL~~r~`~ GFt-1C~
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
Original Appointment ~ Deputy Treasurer ~ Reappointment of Treasurer ~ Secondary Depository
Name of Candidate 1. Address (include post office box or street, city, state, zip code)
~ ~ r~' ti% 'Tz~
y 7 ~ ~
~~
l~f l~if~~~~ 5~ .
. M ,~ r ~ ~ ~ ~ y ~
Telephone (optional) 2. Party (Partisan candidates only) 3. Office (add district, circuit or group number)
.~~y~~,~
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) ~
~}7~0 ~q~r~ti' ~~~a~ ~~~ ~~ _~ ~~~~~ 6. Telephone
~t~s ~3i os.~~7
7. City
~~ j ,~ 8. County
I`'! 1.11/ 7,qI~ 9. State
~/~ 10. Zip Code
~ ~ ~ Y v
I have designated the following named bank as my Primary Depository Secondary Depository
11. Name of Bank 12. Street Address
13. City
~~~~ ;~ 14. County
,~ ~ L 15. State
~ L-- 16. Zip Code
> j l CLG>
17. v n ture of a Date ~y
^
A , / y ~
7
Campaign Treasurer's Acceptance of Appointment
~ ~
1, _ ~: ~ `~ ~/ ~ ~i`1 ~ ~'~ ~ ~ ~ ~ ~ ~ , do hereby accept the appointment as
(Please Print or Type)
Campaign Treasurer ~ Deputy Treasurer for the campaign of ~T.` , ~~~ i~`1 ~ ~i~Lq~ ,
who is seeking nomination or election as a / ~~ ~ 7 candidate to the office of
(Party)
f~ 1
~/ ~ ~ As a duly registered voter in i1~/,,~h~-~~~ t
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.
,, j ~ r
r ,
Date / Si
f C
i
gn re o
ampa
gn Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 08/03)