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HomeMy WebLinkAboutDepository AmendedDS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C. R�c�II'EO APPOINTMENT OF CAMPAIGN TREASURER �?ro� I �3?� 1G AND DESIGNATION OF CAMPAIGN �l'b'of, y DEPOSITORY FOR CANDIDATES �'c,l, basun Cf�ce (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) NOTE: This form must be on file with the qualifying officer before opening the campaign account. I OFFICE USE ONLY 1. CHECK APPROPRIATE BOX(ES): 0 Initial Filing of Form Re -filing to Change: [Treasurer/Deputy [3 Depository ❑ Office ❑ Party 2. Nam of C ndidate (in this order: First, Mid, Last) , 3. Address (include post of/ficce box or street, city, state, zip code) 1_ c�� /�h //�/ eft S / '� 4. Telephone 5. E-mail address Pj9n / 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if JJ %% applicable: ❑ My intent is to run as a Write -In candidate. 8. If a candidate for aap rtisan Office, check block and fill in name of party as applicable: My intent is to run as a ❑ Write -In ❑ No Party Affiliation Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. Nam of /Treasuurreer or puty Treasurer 77eo ` � / i 9 Y v 11. (7?a)o2aS-s O 13 C' 414 /_ 14. County15. State rl- 16?. Zi�p]Code 17. E-mail address / �� I J z% j 1 4 Z yr l�L° '3')! �M� �P ✓ 4� /� o M4 , 18. 1 have designated the following bank as my ©Primary Depository ❑ Secondary Depository 19. Name of Bank 21. City 22. County 23. State 24. Zip Code 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. Signa/vtu f Candida S)/) 3 o d X 27. Tireasu�reerr/'s Acceptance of Appointment (fill in the blanks and check the appropriate block) /' 11 I, / Y do hereby the 9 (� - 1� l , accept appointment (Please Print or Type Name) designated above as: L� Campaign Treasurer ® Deputy Treas er. 3 X Date Signature of Campaign Treasurer or Deputy Treasurer DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.