DS-DE 9-1 K.R. Gonzalez STATE OF FLORIDA OFFICE USE ONLY
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES C' o
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) r'--,,
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1. CHECK APPROPRIATE BOX: ° r 711
Original Appointment Change in: reasurer/Deputy ❑ Depository Offie -❑ Party
2.Kae of Candidate in this order: First, Middle, Last) 3.Address (include post office box or stret, city, state, zip
6Vl2Ci t code) �V1 ✓�
4. Telephone (optional) 5'./E-mail address (optional) ��l
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6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office,check if
applicable:
r C�o() ❑ 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 ❑ Campaign Treasurer Deputy Treasurer
10. Name of Treasurer oeputy Tr r
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11. Mailing Address(If post office box or drawer also include street address) 12. Telephone
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13. City 14. County 15. State 16. Zip Code 1 17. E-mail address (optional)
' �_4 b FL, 1 J31 L41
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Nam of Bank 20. Street Address
Nam
21. City �� 22. County 23.23. Stat�� 24. Zip Code
33
UNDER PENALTIES OF PERJURY,1 DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND TH T#F FACTS STATED IN IT ARE TRUE.
25. Date 26. Si u,' ' f Candidate
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27. Tre Sur 's Acceptan a of Appoint ent(fill in the blanks and check the appropriate block)
I, �1�, ��� do hereby accept the appointment
fir- � �'�` Y P PP
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer f2, Deputy Treasurer.
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D to ig ature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 11/09)