DS-DE 9 Amended Berke APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN L
DEPOSITORY FOR CANDIDATES 20M I SEP —9 PM! 2: 03
(Section 106.021(1), F.S.)
CLEM
(PLEASE PRINT OR TYPE) CITY 'S 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):
El Initial Filing of Form Re- filing to Change: Treasurer /Deputy El 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
5 -4-64 code)
4. Telephone 5. E -mail address
(3 °C--) 672 8-954t/610erkera:i. 6. Office sought (include district, circuit, group n r) 7. If a candidate for a nonpartisan office, check if
applicable:
ilA 6,y or El 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
Write -In MOP No Party Affiliation ❑ Party candidate.
9. I have appointed the following person to act as my El Campaign Treasurer 5:3 Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
RAJ ask
11. Mailing Address 12. Telephone
/ - 1oy of e ('(CL Dr ( 3DS) 6 7? cPcUcP-
13. City / 14. County 15. State 16. Zip Code 17. E -mail address
Ott# MI 664d t,r /� . awi . -'E �-- 33, u I S-�-t . bei-Ackikte -,
18. I have designated the following bank as my EKPrimary Depository 0 Secondary Depository
19. Name of Bank 20. Address
P i t '(0 4/6X dot e`p 4(-
21. City 22. County 23. Sta 24. Zip Code
II
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. Signatures o an.'. - to
IZZ11 '�
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
, do hereby accept the appointment
(Please Print or Type Name)
designated above as: D Campaign Treasurer 0,--Beputy Treasurer.
7/f/g X
Date Signature o ampaign reasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.
-_ r