HomeMy WebLinkAboutDS-DE9 STATE OF' FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF ~~lt~It~POSITORY
FOR C~i~E~H I0: I~ ]
(Section 'f1~:021'(1')', F.S.)
(PL~~~K'S OFF ICE
Name of Candidate
CHECK APPROPRIATE BOX
E~riginal Appointment
D Deputy Treasurer
~'~ Reappointment of Treasurer
D Secondary Deposi;ory
1. Address (include post office box or street, city, state, zip code)
Telephone (optional) 2. Party (Partisan candidates only) I 3. Office (add district, circuit or group number)
( )
4. Name of Treasurer or Deputy Treasurer
5. Mailing Address (If post office box or drawer add street address)
7. City 8. County 9. State
N h,0-
I have designated t~ following named bank as my
Prima~
~posito~
6. Telephone
10. Zip Code
Secondary Depository
11. Name of Bank
13. City I
17. Signature of Can~
12. Street Address
14. County ~5. State
16. Zip Code
Date
Campaign Treasurer's Acceptance of Appointment
~] Campaign Treasurer
(Please Print or Type)
'"--]Deputy Treasurer
for the campaign of
who is seeking nomination or election as a a~,l~~~a~;~
·
County. Florida. I am qualified to accep! this appointment.
, do hereby accept the appointment as
candidate lo the office of
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING CAMPAIGN TREASURER'S
ACCEPTANCE OF APPOINTMENT AND THAT THE FACTS STATED ARE TRUE.
Date
SignatUre of Campaign Treasurer or Deputy TreaSurer
DS-DE g (Rev. 11101)