HomeMy WebLinkAboutDS-DE 9 CAMPAIGN TREASURER & DEPOSITORYDS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURERC�
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AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
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(Section 106.021(1), F.S.)
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(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Ej 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
code)
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4. Telephone
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5. E -mail address
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6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
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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 Campaign Treasurer ® Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address
12. Telephone
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13. City
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14. County
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15. State
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16. Zip Code
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17. E -mail address
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18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank
20. Address
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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. Signature of Candidate E
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, 104 ,� � � , do hereby accept the appointment
(PI ase Print or Type Name)
designated above as: 14 Campaign Treasurer Deputy Treasurer.
Date Signature of Campaign Trbasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.