DS-DE 6 North Beach Neighbors Alliance .�
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGNS 'e'1 =
DEPOSITORY FOR
POLITICAL COMMITTEES (�r
(Sections 106.011(1)and 106.021(1),F.S.)
CHECK APPROPRIATE BOX: OFFICE USE ONLY
.l Original Appointment of Treasurer El Reappointment of Treasurer El Deputy Treasurer
1. Committee or Organization 2.Telephone
IV 0 8CCA--C+I 'e f h .cv (6!7 ) d-rt/Y
3. Name of Treasurer or Deputy Treasurer 4. Email(optional) 5.Telephone(optional)
662—k 104 ` Cf, "r
6. Mailing Address
3 .� tht---d9 ) � t 9 -1}2iia (11(M44 /Ca‘4/
7. Street Address
8.The following bank has been designated as the /i. Primary Depository El Secondary Depository
9. Name of Bank 10.Street Address
lCity 12.State 13.Zip Code
41 v I% ` f � ' 7?/(-4/
14. Signature o hairman 15. Name of Chairman(Print or Type)
— /14(-4//1 C-AN
Campaign Treasurer's Acceptance of Appointment
I, 64, IC. ' ,do hereby accept the appointment as
(Please Print or Type)
treasurer or deputy treasurer for ; 6/Ca-tt fr /4
(Committee or Organizat n)
UNDER PENALTIES OF PERJURY,I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT T FACTS S D ARE TRUE.
f lq - —
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 6(Rev.7/10)