DS-DE 9 De Leon APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN'
DEPOSITORY FOR CANDIDATES 2011 AUG 19 PM 2 14
(Section 106.021(1), F.S.)
S OFF ICE
(PLEASE PRINT OR TYPE) CITY €i
NOTE: This form must be on file with the qualifying
officer before o • enin • the campai • n account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
X Initial Filing of Form Re- filing to Change: Treasurer /Deputy El Depository ; Office X! Party
2. Name of Candidate (in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
; .4()E LL-61A/ code) 5/0/ / deit/ALS , 9a6 / Ir
fr\ A "seAiz-4 /Yo
4. Telephone 5. E -mail address
(3 ° 99.77 1'06 c12 -DC- L VormlokselYn
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
c2_o, , , S 5/ O N applicable:
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
X Write -In No Party Affiliation /VA Party candidate.
9. I have appointed the following person to act as my IX; Campaign Treasurer r Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
Isaac Rosenblum
11. Mailing Address 12. Telephone
4045 Sheridan Ave., #123 ( 305 ) 434 -2376
13. City 14. County 15. State 16. Zip Code 17. E -mail address
Miami Beach Miami -Dade FL 33140
18. I have designated the following bank as my Primary Depository 1 Secondary Depository
19. Name of Bank 20. Address
21. City 22. County 23. State 24. Zip Code
M/1)11/ 6 c'•,4/ MAH/ D.00 33/5
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND TH FACTS STATED IN IT ARE TRUE.
25. Date 26. Sic nat r- of Candidate
- 1 0 l -z01 X ,�,,;,
27. Treasurer's Acceptance of Appointment (fill in t ' e bl.: ks an • check the appropriate block)
Isaac Rosenblum , do hereby accept the appointment
(Please Print or Type Name)
designated above as: X Campaign Treasurer Deput Treasurer.
III
Date Si ature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.