DS-DE 9 - Berke APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN RE . C F I
DEPOSITORY FOR CANDIDATES
(Section 106.021(1 F.s.) 1Q11 JAN 27 PM 4o 52
(PLEASE PRINT OR TYPE) CITE` CLERKS OFFICE
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
jai Initial Filing of Form Re -filing to Change: 0 Treasurer/Deputy j] Depository El Office El Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office ox or street, city, state, zip
:z;::((AJe b.‹.(- fr-e- /t4 /4 �;r�� code) ct ( le �Vc` t/�( o l ► /
4. Telephone 5. E -mail address , Ait k ���� f/. 33/ L(/
(2 19S ) .cp 0 / D 3 ' 5+41/ 'elkee54/Yt(4 • t st-44/
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
/14, c i ' El My intent is to run as a Write -In candidate.
8. If a candidate for partisan office, check block and fill in name of party as applicable: My intent is to run as a
0 Write -In 0 No Party Affiliation L!11 - 1 1 \c_ 1 ITT"' e Party candidate.
9. I have appointed the following person to act as my p Campaign Treasurer 0 Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer at Covk AlkCil (
/
11. Mailing Address ` � 12. Telephone
b DO ,✓ 6 3 6 s e (4 ► `( AA i avv1 i Ft 331,3f( R io ) 1,6 3 '7 </
13. City 14. County 15. State 16. Zip Code 17. E -mail address
M ' Avvt i NI i t 4 PK: '-alk F-1. 33 1 3 A-A 911, - c-L t . itr &,1 A. ( (
18. I have designated the following bank as my p Primary Depository 0 Secondary Depository
19. Name of Bank n i 20. Address
10 6t-A 1 (‘I
P4 0 ( b/.5 Co( ci 4A 6
21. City 22. County 23. State 24. Zip Code
.-/--X l M('( 6/4-DC- f:; 331 /
UNDER PENALTIES OF PERJURY, I DECLARE THAT 1 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 of idate
I tg 7 // / X
27. Treasurer's Acceptance o Appointment (fill in the b auks and check the appropriate block)
1, 4 01 � 141 i (n. C )1'.Q r , do hereby accept the appointment
p ppointment
(Please Print or Type Name)
designated above as: [ZI Campaign Treasurer El Deputy Tres rer.
VD-`7/ I i X 64 f/1*7
Dat
Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 15- 2.0001, F.A.C.