DS-DE 9 Mohammed Rafiqul Islam APPOINTMENT OF CAMPAIGN TREASURER �? o
AND DESIGNATION OF CAMPAIGN w
DEPOSITORY FOR CANDIDATES C ;-r
(Section 106.021(1), F.S.)
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(PLEASE PRINT OR TYPE) v: s-
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NOTE: This form must be on file with the qualifying _
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officer before opening the campaign account. 2gFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re-filing to Change: F] 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
P` O VVAMMEl7 R_AFI a01- Xsl.Ac1`'1 code) % ,
J c64 j 131tR-Rt'T 2 yR%vF- -tt 3 1A-�41 ►31=Ac.
4. Telephone 5. E-mail address - 331A
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
4:& P 1 applicable:
❑ 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
M ❑ Write-In E] No Party Affiliation 0 Party candidate.
9. 1 have appointed the following person to act as my Q Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
RAH P1ZAsa D PAUL-
11. Mailing Address 4004, 1"J�iW1J' 2- A-AVg Ai Z 12. Telephone
(+Ss(, ) + -&&19
13. City 14. County 15. State 16. Zip Code 17. E-mail address
MNtMI 6EAC 4 ' DAM- 53141 12icH O
18. 1 have designated the following bank as my ® Primary Depository Secondary Depository
19. Name of Bank C-4 4A47 20. Address
`4-4 l 2V wdlz b"j) r5,LE
21. City 22. County 23. State 24. Zip Code
MrA � ISSAC 14 D-orof_ CL_ - 1 331
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. Signatu 7oandidate
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27. Treasurers Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, 1?A114 P12-A 6A> ?^l}I— , do hereby accept the appointment
(Please Print or Type Name)
designated above as: ® Campaign Treasurer E] Deputy Treasurer.
0 r.16412-01 X Z_,
% Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.