DS-DE 9-2 KRGonzalez APPOINTMENT OF CAMPAIGN TREASURE_R
AND DESIGNATION OF CAMPAIGN 1 `= ��
DEPOSITORY FOR CANDIDATES 2013 MAY 21 PM 2: 46
(Section 106.021(1), F.&)
(PLEASE PRINT OR TYPE) C I T Y f"L L i K'S 0 F F I'-':F
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: Treasurer/Deputy ❑ Depository C-] Office Party
2. Name of Candid roltIA( this order: First, Middle, Last) 3. Address (include post`office box or street, city, state, zip
I� Jce
'�Z- code) 1 -5zq ' vff47
4. Telephone 5. E-mail address
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
to M M I S 61 rrq My intent is to run as a Write-In candidate.
8. If a candidate for a partisan office, check block and fill in name of party as applicable: My intent is to run as a
Q 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 or Deputy.Treas r
11. Mailing Address � f n D � 12. Telephone
13. City 14. County 15. State 1 16. Zip Code 17. E-mail address
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank ��� � 20. Address '(/
a QJ
21. City 22. County 23. State 24. Zip Code
I'v1.P ,rA cD �wti _f_� ( 3 1�i
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREG;INIFO' FPL4 FOR APPOINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND TH E t TS STATED IN IT ARE TRUE.
25. Date 26. Sig f C ndidate
jv
27. Treasurer's Acceptance of Appointment (fill in the bla s and ch ck the appropriate block)
I, 4/2 A l Q f- I do hereby accept the appointment
(Pleas rint or Type Name)
designated above as: Campaign Treasurer jTreasr.
LT-//
, 2 v / X
Da Signature ampaig reasurer or Deputy I reasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.