DS-DE 9 1 Crystal APPOINTMENT OF CAMPAIGN TREASURER
DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES 2013 FEB 12 hN 11' 22
(Section 106.021(1), F.S.) _ __
GE I Y �.LE-F; v'%'3` ���-F i�,E
(PLEASE PRINT OR TYPE)
NOTE: Th' 'form must be on file with the qualifying
officer fore opening the campaign account. OFFICE USE ONLY
1.C CK APPROPRIATE BOX(ES):
Initial 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)
OU�- C� 01 �
4. Telephone 5. E-mail address r
�C)5) D-ap,Cv--�t�C;L
6. Office sought(include district, circuit(group number) 7. If a candidate for a nonpartisan office,check if
applicable:
El intent is to run as a Write-In candidate.
8. If a candidate for a ap rtisan 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 Ef Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address 12. Telephone
PG gox
13. City 14. County 15. State 16. Zip Code 17. E-mail address
j \)C,�k FL
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20.Address
::u &0,1,k- 'y oa 51,
21. City 22. Count 23. State 24. Zip Code
16 �(� 13L S
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
a�
l � � X
27. Treasurer's Acceptance of A pointment(fill in the blanks and check the appropriate block)
I, Dc Uut C' , do hereby accept the appointment
(Please P int or Type Name)
designated above as: ❑ Campaign Treasurer Deputy Treasurer.
Date Signa ampaign Treasurer or Deputy Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.