HomeMy WebLinkAboutDS-DE 9 FormDS -DE 9 (Rev. 10/10) - - - ---P ule 1S- 2.0001, F.A.C.
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APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
cgUG 9
DEPOSS O�RY
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6FORICANDIDATES
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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):
12�j 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
Ycode)
PCA, __1
4. Telephone
5. E -mail address
( 77a) 385- 0961
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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 F-1 Party candidate.
9. 1 have appointed the following person to act as my J] Campaign Treasurer ® Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
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11. Mailing Address
12. Telephone
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,5c) 1 V, �Jf �� �c�b ;v._ "�.- 325 -S —E
(7 %,�) 3 - O 16 l
13. City
f 14. County
15. State
CL
16. Zip Code
3�295H
17. E -mail address.
18. 1 have designated the following bank as my ❑ Primary Depository Secondary Depository
19. Name of Bank
20/. Address 1 1
21. City\\
22. County
23. State
24. Zip Code
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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 Capd 'ate
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
16 CL do hereby the
1,
! 1 rnA - o: accept appointment
(Please Print or ype Name)
designated above as: Campaign Treasurer De reasurer.
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Date Signature of Campaign reasurer or ep�N Treasurer
DS -DE 9 (Rev. 10/10) - - - ---P ule 1S- 2.0001, F.A.C.