HomeMy WebLinkAboutDS-DE9_RedactedAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
C�O
DEPOSITORY FOR CANDIDATES
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(Section 106.021(1), F.S.)
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(PLEASE PRINT OR TYPE)
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NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Treasure Office Party
❑ Initial Filing of Form Re- filing to Charge: 21,
De ❑ Depository ❑ 0
2. Narne of Candidate this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
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code}
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4. Telephone
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 -
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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 Depureasurer
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11. Mailing Address
12. Telephone
13, City 14. County 15, State
16. Zip�]Codg-;,
17. E-mail address /]
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18. 1 have designated the following bank as my [.Primary Depository ❑ Secondary Depository
19. N me of Bank 24. Address
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21. City
22. County 23. State
24. Zip Cade
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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR APPOINTMENT OF CAMPAIGN TREASURERAND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
25- bate
26- Signature of Candidate
27, Treasurer's Acc tance of Appointment (fill in the blanks and check the appropriate block)
I, r rvw � r 4 L14 — do hereby accept the appointment
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(Please Print or Type Dame)
designated above as: ❑ Campaign Treasurer 2re Deputy Treasurer
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Date Signature dt Campaign Treasurbr or Deputy Treasurer
DS -DE 9 (Rev. 10110) Rule 1S- 2.0001, F.A.C.
DS -DE 9 (Rev. 1 Oil 0) Rule 1S- 2.0001, F.A.C.
APPOINTMENT OF CAMPAIGN TREASURER��+'`()
AND DESIGNATION OF CAMPAIGN
c,4tjG,?
DEPOSITORY FOR CANDIDATES
C� ofS J�
(Section '306.[921(1), F-S_)
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o
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
ECK APPROPRIATE BOX(ES):
t Initial Filing of Farm Re- filing to Change. ❑ TreasurerfDeputy [] Depositary Q Office Ej Party
2. Name of Candida (in this order: First, Middle, Last)
7,
3. Address (include post office box or street, city, state, zip
code}
r ,�" `�
4. Tele hone
5. E -mail address
/f
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
(gip
applicable.
❑ My intent is to run as a Write -In candidate_
J ra ry a �`1 [� ,r� C,
8. If a candidate for a partisan office, check block and fill in name of party as applicable: filly 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. Nape of Treasurer rc� putyyTreasurer
1�I n,
11. Mailing Address
12_ Tele hone
13. City 14. Cjpunty 15, State
16. Code
17. E -mail address
-. SJ ?.� f1[ri�:4. !�1'�'G
}Zip
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i J✓ltf+ /1Glyv�3 +r, CLl!'°
18. I have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Na,/ e of Bank /
20. Address /
21. City -
22. County
�1:
23. State 24. Zip Code
— - 95 J + t1 t
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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 ]TARE TRUE.
25. Date
Signature offCCand[date
r26.
27. / Treasurer's Ac- ptance of Appointment (fill in the blanks and check the appropriate block)
/1i
1, /-moo +Lj J A KIL � do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer Deputy T f
Z X '
Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 1 Oil 0) Rule 1S- 2.0001, F.A.C.