DS-DE 9 Urquiza APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN R F C F 1 V E D
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) 2011 FEB —4 PM 12: 57
(PLEASE PRINT OR TYPE) CITY CLERKS OFF ICE
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. 9HECK APPROPRIATE BOX(ES):
' HECK
Filing of Form Re- filing to Change: El Treasurer/Deputy El Depository ❑ Office El Party
2. Nae of Candid te (in tF�is order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
E f 5 eL Ceautzet_ code) 7 Ri,l O 41 b
4. Telephone 5. E -mail address Ai ;e en ; ?e,4-(,4 i ,C/ 3 3 7 5"I
(305 )6 -9040 eiscc ai24
(e�� C� JB//s0uf4.yjet
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
CPA/ fli.c.5/ - -Jteiwt
-�/ T 0 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
EI Write -In J No Party Affiliation ❑ Party candidate.
9.1 have appointed the following person to act as my I Campaign Treasurer 0 Deputy Treasurer
10. Name of .Qayurer or eputy Treasurer /
.� &a,^ 14 , � a n 4O 5
11. Mailing Address 12. Telephone
/ 4/ Col / s Ave . (305) $o4-860g
13. City ,? 14A Coun 115 State 16. Zip Code 17. E -mail address
/1 Xi ,d.�.4 V A _P.-- ?3 /#
18. I have designated the following bank as my [r Primary Depository El Secondary Depository
19. Name f Bank 20. Address
C p a se Q/�� -; � d.
21. it 22. Cou 23. te / 24. Zip Code
Ztc-c-i;
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 (�J / /I� 26. Sign f Cand _t_ r----
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the ppropriate block)
I, Cd....ard C }0 % , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Li Campaign Treasurer 0 Deputy Treasurer.
Z/7 / II X
Date Signature o C- u • - easurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.