DS-DE 9 MGongoraOFFICE USE ONL'i`f ` ' ~~ r t~/'~
STATE OF FLORIDA 2009MdR _S ply
APPOINTMENT OF CAMPAIGN TREASURER ~,~ I. ,f ~'L r .- 14• $ J
AND DESIGNATION OF CAMPAIGN ~ ~
DEPOSITORY FOR CANDIDATES ~ S (,j,~ !L'r..
(Section 106.021(1), F.S.)
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
a Deputy Treasurer Q Reappointment of Treasurer
Original Appointment
Name of Candidate 1. Address (include post office box or street, city, state, zip code)
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Partisan candidates only) 3.Office (add district, circuit, roue number)
Telephone (optional) 2. Party ( G rv ~P ~ ~ i-~l ~
I have appointed the following person to act as my a Campaign Treasurer ~ Deputy Treasurer
4. Name of Treasurer or Deputy Treasurer
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o-'~
5. MaAing Address (If post office bo or drawer add street address)
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' ~ 6. Tele hone
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5 831J ~ ~ (~r.~
7. city ,Q -
8. County ..
9. State (~~
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~ 10. zip Code
33 I ~O
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I have designated the following named bank as my Liy
11. Narne of Hank
13. City 14. County
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17. Signature of Candi ate
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Campaign
Campaign Treasurer
(Please,p~tftt or Type) Y
„Deputy Treasurer for the campaign of ~~ ~ ~ ~ v ~~"~
~y
who is seeking nomination or election as a
Primary Depository ~ Secondary Depository
12. Street Address ~~ U~
15. State 16. Zip Code
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Acceptance of Appointment
do hereby accept the appointment as
~ t `~• candidate to the office of
,,~~ l / l1 / (Party)
UNDER PENALTIACCEPTANCE OFIAPPO NTMENT ANDATHATR THE FACTS STAGED AR~RUE.N TREASURER'S
r
Date Signature of Campaign Treasurer o uty Treasurer
DS-DE 9 (Rev. 01/08)