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Appointment of Campaign TreasurerSTATE OF FLORIDA ~ ~4U,~LY APPOINTMENT OF CAMPAIGN TREASURER 2001 SEP -( PM ~' 3U AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES CITY C~ E~K'5 4~F iCE. . (Section 106.021(1), F.S.) (PLEASE TYPE) CHECK APPROPRIATE BOX: ^ Original Appointment Deputy Treasurer ^ Reappointment of Treasurer ^ Secondary Depository Name of Candidate `~ ~ C ~ 1. AAd~.d,(ress~~(''iJJnclude post office boxgo~r street, c~ity,~stante, zip code) +~J/~Y/y" ~ f ~ Telephone (optional) 2. PartvlPartisan 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 Treasu 5. Mailing Address (If post office box r dr add street address) 6. Telephone 7. City//~~ ~ocf~ ~~~~ 9. State ~ 10. ~~ ` I have designated the following named bank as my ^ Primary Depository ^ Secondary Depository 11. Name of Bank 12. Street Address 13. Ci 14. Coun 15. State 1--~/ 7L~ 16. Zip Code ~,~ 17. Sig ture of Candidate x Date 9-- _a Cam ign Treasurer's Acceptance of Appointment t s i t ~~ men a n , do hereby accept the appo I (Ple se Print or Type) r ^ Campaign Treasurer ~ Deputy Treasurer for the campaign of / f' who is seeking nomination or election as a candidate to the office of Y) ~ c -~ a duly registered voter in ~ 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. r © X i t o of Campaign Treasure r puty Treasurer Date 9 DS-DE 9 (Rev. 02/06) ~`,~