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APPOINTMENT OF CAMPAIGN TREASURER FcRy�Fp
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FORCANDIDATESCYCofc,
(Section
(PLEASE PRINT OR TYPE) or
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
N Initial Filing of Form Re -filing to Change: ❑ 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
LDJI$� /''�, 7iAJi�IJ'bil� code)
i 8
4. Telephone 5. E-mail
address
(77.Z ) 6?4-39/l0
6. Office sought (include district, circuit, group number) 1 7. If a candidate for a nonpartisan office, check if
l�t j" t?OIJ v� j / 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
❑ Write -In ❑ No Party Affiliation ❑ / Party candidate.
9. 1 have appointed the following person to act as my
10. Name of Treasurer Deputy Treasurer
4,4o e,4
11. Mailing Address
1.si9 64 1d'
NCampaign Treasurer ❑ Deputy Treasurer
12. Telephone
(tea ) 633 -84 -7/
13. City 14. County 15. State 16. Zip Code 17. E-mail address
6e.4467_i'.4,t) 1, tl,-e- /--/ 1 3-;�%62P I A -re i3 #�3,e Ad Cow
18. 1 have designated the following bank as my V Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
13A4)e OP fi A 4e,6C,4 1 ')/a s, Fle.4tet .0 jl .S
21. City 122. County 23. State 24. Zip Code
5AA 4 nJ d I AA) k6i' ve-e— I r 3a9ss
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�f 26. Signature of Candidate
�J
4 o
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block
I, L,4op R 147-ei'.SeA , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy Treasurer.
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.