HomeMy WebLinkAboutDS-DE 9 STATE OF FLORIDA
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021 (1), F.S.)
(PLEASE TYPE)
CHECK APPROPRIATE BOX:
~Original Appointment
Name of Candidate
Deputy Treasurer
OFFICE USE ONLY
RECEIVED
05 28 2:36
CITY ""
2. Party (Partisan candidates only)
r--] Reappointment of Treasurer [~ Secondary Depository
I1. Address (include post office box or street, city, state, zip code)
3. Office (add district, circuit or group number)
rTelephone (optional)
I have appointed the following person to act as my E~ampaign Treasurer [] Deputy Treasurer
4. Name of Treasurer or Deputy Treasurer
5. Mailing Address (If post office box or drawer add street address) I 6. Telephone
11. Name of Bank
7. City 8. County I 9. State - J 10. Zip Code
I have designated the following named bank as my Deposito~ ~ Seconda~ Deposito~
12. Street Address
¢IrT
17.X ~__~Si°nature of Candidate~,,~ ~~' ~" I] Date
I-~E-~ ~
-/ / Campaign Treasurer's Acceptance of Appointment
(Please Print or Type)
, do hereby accept the appointment as
~camPaign Treasurer [] Deputy Treasurer
who is seeking nomination or election as a
for the campaign of ~) C,,,~,,~ ~'
(Party)
candidate to the office of
y'2:~,'"~~' /fft',,4~-/' C.~.'-~ ~'~/7'...-/J~.,r;'~,.~' . as a duly registemd voter in ~-~,'-
county, Flodda, I am qualified to a~pt this appointment.
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 ~g ture~a~paign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 08/03)