DS-DE 9 2 Crystal Janas APPOINTMENT OF CAMPAIGN TREASURER ' ° j"'f
AND DESIGNATION OF CAMPAIGN 2013 FEB 12 AM 11: 22
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) CITI' [;L ;`;, = I`:i.
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officeVbefore opening the campaign account. OFFICE USE ONLY
1. C ECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy ® Depository ❑ Office ❑ Party
2. Name of Candidate(in this rder: First, Middle, Last) 3.Address(include post office box or street, city, state, zip
Al �r code)
4. Telephone 5. E-mail address
(30-x) ?)1(3 `�� 1 a��. C� '� C �OV5-6
Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
o�,amiss/Q, ✓ ,l/�J . r ��G� ❑ My intent is to run as a Write-In candidate.
8. If a candidate for a. as 1p tisan office,check 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 Campaign Treasurer ❑ Deputy Treasurer
10. Nam of Treasurer or De uty Treasurer
aAas
11. Mailing Address 12. Telephone
6b�;7 ��iG /' n fie,, (6a l )
k. City 14. Count 15. State 16. Zip Code 17. E-mail address �^V""�n�
3 P
. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20.Address
21. City 22. County 23. State 24. Zip Code
r4u,,; c : .�L 33�a�
3
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 ndidate
Z�"13 x
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
j
11, P4 u ( 3ca n a -5 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: 19/ Campaign Treasurer Deputy Treasurer.
Date Sign ture of Campa Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.