DS-DE 9 -1STATE OF FLORIDA ~ ~ ,~j~sLY
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN ZOO1 SEP -6 PM 3~ 30
DEPOSITORY FOR CANDIDATES
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(Section 106.021(1), F.S.) ~ ~ l~~ ~• ~. ~ `` ~`'~ c ~ )~
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
^ Original Appointment Deputy Treasurer ^ Reappointment of Treasurer ^ Secondary Depository
Name of Candidate 1. )Ad~d)ress (include post office box or street, c~ity~st~a~te, zip code)
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Telephone (optional)
(~ ) 1 2. Part Partisan candidates only) 3. Office (add district, circuit, group number)
I have appointed the following person to act as my ^ Campaign Treasurer eputy Treasurer
4. Name of Treasurer r Deputy Treasur
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5. Mailing Address (If post office box r draw add street address) 6. Telephone
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7. City „~~ ~o~n<E~~y ~, /~ 9. State ~ 10. Z~a~ ~ ~ 1.
I have designated the following named bank as my ^ Primary Depository ^ Secondary Depository
11. Name of Bank 12. Street Ad
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ess
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13. Cit /l 14. Count , 15. State ~^
~ 16. Zip Code
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17. Sig ture of Candidate Date
Cam ign Treasurer's Acceptance of Appointment
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, do hereby accept the appointment as
(Ple se Print or Type)
^ Campaign Treasurer ~ Deputy Treasurer for the campaign of / f- ~~ ~
who is seeking nomination or election as a candidate to the office of
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a duly registered voter in ~ _~~
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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.
X
Date ig at e of Campaign Treasurer orbeputy Treasurer
DS-DE 9 (Rev. 02/06)