DS-DE9
STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN DEPOSITORY
FOR CANDIDATES
(Section 106.021(1), F.S.)
CHECK APPROPRIATE BOX
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o Original Appointment
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o Deputy T~surer >;l
o Reappointn;~nt 6~rea~er
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1, Address (include post office box or street, city, sIii\,e, Ziji'codE!)
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2. Party (Partisan candidates only) 3, Office (add district, circuit or group number)
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0" Campaign Treasurer 0 Deputy Treasurer
(PLEASE TYPE)
Name of Candidate
Telephone (optional)
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I have appointed the following person to act as my
I have, designated the following named bank as my
11, N'W'e of Bank
Gol...ON
13, City
6, Telephone
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10, Zip Code
3,3\+0
o Secondary Depository
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7, City
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15, Slate t6, Zip Code
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I WILL NOTIFY YOU OF ANY ADDITIONS OR CHANGES TO THESE APPOINTMENTS.
Campaign
Date
17, xnatureof candi~
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O~ 0"'1. 0 \
asurer's Acceptance of Appointment
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(Please Prinl or Type)
, do hereby accept the appointment as
G2r Campaign ~reasurer 0 Deputy Treasurer for the campaign of '-,,\""'5 E.
who is seeking nomination or election as a ~t91~,<\. ~~ 1 I\J (Non-partisan)
Gw~ ~ (Party)
t~ ~lY) M, 5~ ( f>N '" ,~ . As a duly registered voter in ''^-<. AM I - ~ tAt) t:
t"">.l"'QSSON'
nd,date to the office of
County, Florida, I am qualified to accept this appointment.
O&~Oq-OI
. Date
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Signature
Treasurer
OS-DE 9 (Rev. 11/95)
STATEMENT OF CANDIDATE
(Section 106.023, F.S.)
(Please Type)
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candidate for the office 0 II f) L"> ~
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have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1 )(c), 106.265(1), Florida
Statutes);
DS-DE 84 (Rev. 8/99)