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HomeMy WebLinkAboutDSDE 9 PPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES (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. 1. CHECK APPROPRIATE BOX(ES): 21 Initial Filing of Form Re -filing to Change: ❑ R�cF��EO jf 2p?o L� kebast/an eII;ce OFFICE U: E ONLY Treasurer/Deputy ❑ Depository ❑ Office [] Party 2 Name of Candid/ate (in this order- First, Middle, Last) 3. Address (include post office box or street, city, stats, zip o //// code) �,� 5d9 4. Telephone 5. E-mail address 170 MMnvj<d l (t_�iOM v . fl S�l4 L JTi 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if applicable: c My intent is to run as a Write -In candidate. 8. If a candidate fora 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 candidaa. 9. 1 have appointed the following person to act as my ® Campaign Treasurer [] Deputy Treasurer 10./�ame�of Tre sur r or Deputy Treasurer (.C�-1-0 11. Mailing Address 12. Telephone 50g �, � ,� G(/�t'Gr (77z) 1!5-3) 26 13 ty f 14. Co�}rity 15. State 16, Zip Code 17. E-mail address sT �/� 1%l770� rl V`rn/1) �L ��r S� cL, �j Siit�liLi S c m r,'r_ -Cosy 18. I have designated the following bank as my © Primary Depository ❑ Secondary Depository 19. Name 2 ddress 21 I 22. Count 23. St a 24. Zip Code �sr�°AA1 `Try(-1. =395s3 UNDER PENALTIES OF PERJURY, 1 DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREAS )RER AND DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE. 25. Date 26. Suture of jCai L pZ 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) I• Wa%lr7-sri-/P p Z, _S//, i,7c9/, do hereby accept the appointment (Please rent �S or Type Name) designated above as: ® Campaign Treasurer ❑ Deputy Treasurer. zi12 X 11 "Sl" Date Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.