APPOINTMENT OF CAMPAIGN TREASURER- DS-DE9APPOINTMENT 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 openin.9 the campaign account.
OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re- filing to Change: ❑ Treasurer /Deputy Depository ❑ Office 0 Party
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
M I R2 14�-A � O L�i>>41) d3 i4 5
code) 6-6q N E g S111 sr
Iv� �}rn SibP -Es IF L 36 (-j D
4. Telephone
5. E -mail address
LAM IPNRFA @ o malCA
(-30s- )i - Raab-
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
'C ui 1 Gk 1��rSbY� E] My intent is to run as a Write -In candidate.
8. If a candidate for a ap rtisan office, check block and fill in name of party as applicable: My intent is to run as a
U Write -In ❑ No Party Affiliation E] Party candidate
9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
A Ni-V- o N .i S +f R LAS
11. Mailing Address
12. Telephone
SCSI -e-
(g I (0) 4V
13. City
14. County
15. State
16 Zip Code
17. E -mail address
0,s h edeesti @ I Mal' 1 C
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank 20. Address
V� 1E, LL S IF A-, C o 9 8 g C7 NE 2'`d Avl_
21. City
22. County
23. State
24. Zip Code
M�c,,v1A'\ S
:
-3 S.
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. Sign r of Candidate
31-ib1
X
27. Treasurer's Acceptance of Appointment (fill ' the bier d check the appropriate block)
I, �'� i � {� .� p , do hereby accept the appointment
(Please Print or Type Name)
lesignated above as ❑ Campaign Treasurer Deputy Treasurer.
ao(q x
/lignaturo dampaign ea urer or bthputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.