DS-DE 9 Jorge Expositoi
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APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES M
Section 106.021 1 F.S.
CC) -'O °
(PLEASE PRINT OR TYPE) CD
NOTE: This form must be on file with the qualifying n
officer before opening the campaign account. r_-0171`�BE USE ONLY
1.CHECK APPROPRIATE BOX(ES):
�nitial Filing of Form Re-filing to Change: ® Treasurer/Deputy ® Depository Office ❑ Party
2. Name of Candidate(in this order: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
/ code)
65�ja_3 lwelaxad Ave
4. Telephone 5. E-mail address
c is >��� � � �n on 2 C97 04o � W/
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
C�iy1 r'✓11�5/ �'�cl 21C
E] My intent is to run as a Write-In candidate.
8. If a candidate for a ap rtisan office,Aheck block and fill in name of party as applicable: My intent is to run as a
Write-In ® No Party Affiliation ® Party candidate.
9. 1 have appointed the following person to act as my 011"Campaign Treasurer ® Deputy Treasurer
10. Name of Treasurer or Deputy Trea urer 11 1 pa"f'(
11. Mailing Address `/ 12. Telephone
c2115 lqe 13. City 14. County 15. State 16. Zip Code 17. E-mail address (�e_ '/,
Al(ellei �aG�l awl- al �l �/
i
18. 1 have designated the following bank as my 77primary Depository ® Secondary Depository
19. a of Bank 20.Address
fZFe w46r, 6�/9_e k74 '
21. City 22. County 23. State 4. Zip Code
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ear ,� Ile
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 of Candidate
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27. Treasurer's Acceptance of ppointment(fil In the b' n and c e the appropriate block)
I, a- i o , do hereby accept the appointment
(Plea de Print or Type Name)
designated above as: Campaign Treasurer ® Deputy Treasurer.
Date Si n Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.