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STATE OF FLORIDA O~~~CE US ' NL'~(/~
APPOINTMENT OF CAMPAIGN TREASURER ~SEP
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(Section 106.021(1), F.S.)
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(PLEASE TYPE)
CHECK APPROPRIATE BOX:
Original Appointment Deputy Treasurer ~ Reappointment of Treasurer ~ Secondary Depository
Name o Candidat
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l 1. Address (include pos off~~~~e bo or street city state, zip code)
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~ 2. Party (Partisan candidates only) 3., ffice add district, circuit or group number)
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I have appointed the following person to act as my ~ Campaign Treasurer Deputy Treasurer
4. Name f Treasure or Deput Treasurer
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5. Mailing Address (If post o ce b x or drawer add treetad
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I have designated the following named bank as my Primary Depository Secondary Depository
11. N me f Bank
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17. nature of Candidate ~~ Date
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Campaign Treasurer's Acceptance of Appointment
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, do hereby accept the appointment as
(Please Pnnt or Type)
Campaign Treasurer Deputy Treasurer for the campaign of .~'~~~j~.~~
who is seeking nomination or election as a candidate to the office of
(Party)
,
As a duly registered voter in ~ ~' - ~ V
County, Florida, I am qualified to accept this appointment. G
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACT STAT RE TRUE
Date Signature of Campaign Treasurer or Deputy Treasurer
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