DS-DE 9 TobinSTATE OF FLORIDA OFFICE'IJSE ONLY .
APPOINTMENT OF CAMPAIGN TREASURER
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- AND DESIGNATION OF CAMPAIGN ~~,~
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DEPOSITORY fOR CANDIDATES
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ection 1
6.021(1); F:S.)
(PLEASE PRINT OR TYPE). i~~~'t' f;.~~tE''~'~ ~}~ ~I.~F.
1. CHEGKAPPROP.RIATE BOX:
Original Appointment Change in: ^ "Treasurer/Deputy ^ Depository ^ Office. ^ Party
2. Name. of Candidate {in this order: First, Middle, Last) 3. Address;(include post officebox or street,. city, tate,
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4. Telephone (optional)' 5. E-mai ,address (optional).,. s'~ ~~j= ~--
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6. Office sought (include districf, circuit, group number) 7. If a candidatefor a nonpartisan office, c eck if
applicable:
~o~ ~ My intent'is to run as a Write-In candidate.
8. If a candidate for apartisan office, check block and fill in name of party as applicable: My intent is to run as a
~' Write-ln ^ No Party,Affifiation ~ ~ Party candidate.
9.1 have appointed the following person to act as my ,~ Campaign Treasurer. ~ Deputy Treasurer ~.
10. Name of Treasurer or Deputy Treasurer .~~
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11', Mailing:Address (If post office box or drawer, also include street address) . ~ 12. Telephone
13. City" 14. County 4
/ 15. State 16. Zip Code 17. E-mail address (optional) -
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18.`I have'designated the following. bank as my [~' Primary Depository. ^ Secondary Depository
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19. Name of Bank 20. Street Address
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21. City _
22. County o - 23. State ~ 24. Zip Code
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UNDER~PENALTIE$, OF PERJURY, I DECLARE THAT I-HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN. TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE. TRU -
25. Date 26. Signature f Ca a
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27.E ~ Treasurer's Acceptant of Appointment (fill in the blanks and check the appropriate block)
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ereby accept the appointment
(Please Print or Type Name)
designated above as: ~ Campaign Treasurer ^ Deputy Treas
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Date Signature of Campaign Treasurer or Deputy Treasurer
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