DS-DE 9-1 M. Gongora n N
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.) -�
(PLEASE PRINT OR TYPE) C-
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N :-11
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. TOFRICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: ® Treasurer/Deputy ® Depository Office Party
2. Name of Candidate (in this ordergF' st, Middle, Last) 3.Address (include post office box or street, city, state, zip
�)( C�irlS n/ � rI ✓� code)Se3 g
4. Telephone 5. E-mail address IGI✓tZ ��/�Q
(333 - )2rdv - SDI
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
I"1 ,jov- G N c� K�tq applicable:
❑ My 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 51 Campaign Treasurer E] Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
tars-9 �
11. Mailing Address 12. Telephone
-526 - (D� )B66 - 660
13. City /J ,,/ 14. County 15. State 16. Zip Code 17. E-mail address
'M EAI,1i geezl, Iq fe /l i'-0 4v -12z— 1 33/'f/ heYiUP @ uf cP coo x^,
18. 1 have designated the following bank as my � Primary Depository Secondary Depository
19. Name of Mk 20. Address
21. City 22. County 23. State 24.Zip Code
p-kt, I U-D jp(.- __3 3 )%k_f
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. S of Candi at
09C X
27. r' ce tance of Appointment(fill in the lanks and check the appropr(at block)
I, do hereby accept the appointment
(Please Print or Type Name)
designated above as: ] Campaign Tre urer ep ty Treasurer.
�13 _
Date ignatur mpaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.