DS-DE 9 CruzSTATE GF FLORIDA oFFicE usE ONLY
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN ~-~= ~
DEPOSITORY FOR CANDIDATES ~~ ~~ ~~~ ~-~~~
Section 106.021~1y, F.S. .. '~ :-
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CHECK APPRQPRIATE BOX: ~°~:~~ .~ : ~ ~;~
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Original Appointment ^ Deputy Treasurer ^ Reappointment of Treasurer ^ Secvn~ary [~posit~y
Name of Candidate 1. Address include past office box or street, city, ~a#e, zip codey
Telephone optional) 2. Party Partisan candidates oniy~ 3.Offce Ladd district, circuit, group number}
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I have appointed the following person to act as my ~^ Campaign Treasurer ^ Deputy Treasurer
4. Name of Treasurer yr Deputy Treasurer
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5. Mailing Address ~If post offce box or drawer add street address} fi. Telephone
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1. City S. County ~ ~~
~~ ~ ~ 9. State 10. Zip Code
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I have designated the following named bank as my ®Primary Depository ^ Secondary Depository
11. Name of Bank
~ ~ C~~ k ~ N~ 12. S#reet Address
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13. City
M k'~~i ~~~!~ 14, County
~~ 15.5tate 16. Zip Code
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1l. Si nature of Ca a - Date
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Campaign reasurer's Acceptance of Appointment
I ~''~Br c +~ A r ~ t~ ~~ ~ ~ ~-~
~.,... do hereb acre t the a ointment as
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(Please Print ar Typed
Campaign Treasurer Deputy Treasurer for the campaign of ~ o acJ ~ ~ to ~... ,
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who is seeking nomination or election as a ~ ,~ candidate to the office of
(Party
G~ /~ . As a duly registered voter in ~~~i - ~~.~ ~
County, Florida, I am qualified to accept this appointment.
UNDER PENALTIES 4F PERJURY, I DECLARE THAT I HAVE READ THE FQREGDING CAMPAIGN TREASURER'S
ACGEPTANGE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE,
2~ ~ ~ X
Date 5ignatu a of Campaign Treasurer or Deputy Treasurer
DS-DE 9 Rev. 02106