DS-DE 9 2 Dave Crystal R � 6I P V H F :10 APPOINTMENT OF CAMPAIGN TREASURER �DII JAN 2S AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) Y CLERK'S OFFICE
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before o•enin• the cam •ai•n account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
El Initial Filing of Form Re- filing to Change: [Treasurer /Deputy J Depository ID Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last) 3, Address (include post office box or street, city, state, zip
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4. Telephone 5. E -mail address (=L 3 3 (<1
(1 1 1 )11U - C )v"` raw•
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
Y OV o � AA( <�w.r � e �C � � My intent is to run as a Write -In candidate.
8. If a candidate for a partisan, office, check block and fill in name of party as applicable: My intent is to run as a
Ej Write -In E] No Party Affiliation N/A Party candidate.
9. I have appointed the following person to act as my E] Campaign Treasurer Q' Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address 12. Telephone
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13. City 14. County 15. State 16. Zip Code 17. E -mail address
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18. I have designated the following bank as my IV Primary Depository Secondary Depository
19. Name of Bank 20. Address
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21. City 22. County 23. State 24. Zip Code
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UNDER PENALTIES 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 TRUE.
25. Date / 26. Signature • ' . n
/
x
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
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Dcalf- C7f/ , do hereby accept the appointment
(Please Print ype Name)
designated above as: ri Campaign Treasurer De. Tr surer.
/Aik
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.