DS-DE 9-1 M. Gongora Gp IIISTATE OF FLORIDA OFFICE USE ONLY ~ a
APPOINTMENT OF CAMPAIGN TREASURER -=i o ~
AND DESIGNATION OF CAMPAIGN ~ ~
DEPOSITORY FOR CANDIDATES ~ -s-
(Section 106.021(1), F.S.) r-~ ~
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CHECK APPROPRIATE BOX: ~'~ ~~
Original Appointment ~ Deputy Treasurer ~ Reappointment of Treasurer ~ Secondary Depository
of
Candidate
Name 1. Address (include post office box or street, city, state, zip code)
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Telephone (optional) 2. Party (Partis n candidates only)
1~ 3. Office (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 of Treasurer or Deputy Treasurer
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5. Mailing~lAddress (If post offi~c/Je box or aver add street address)
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7. City
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l''1/G,r~~ - ~ ~ 9. State ~~ 10. Zip Code
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I have designated the following named bank as my Primary Depository Secondary Depository
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13.1C,it~y 14. County 15. Sta 16. Zip Code
17. Signat re of~idate Date//
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Campaign surer's Acceptance of Appointment
I, ~ ~ ~, ~ e I (~ ~ C,~~G~.. , do hereby accept the appointment as
(Please Pri Type)
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Campaign Treasurer ~ Deputy Treasurer for the campaign of ~/ (~G~ e ~ a-„'y(!"I ~b/'~ ,
who is seeking nomination or election as a /~ ~ ~' candidate to the office of
Q ~ ~ ~ ~ (Party)
i C,( m / J~ C~Gti/ ~/~%~'+` mot''-' . As a duly registered voter in M~ ~d'YI i ~ ~G~,~
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.
Date Signature of Campaign reasur Deputy Treasurer
DS-DE 9 (Rev. 08/03)