DSDE9 - Martinez.1.,;,.,i,
MIAMI SHORES VILLAAE,. MIA, MI -D'ADE COUNTY*.
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DS -DE 9 (Revl 10/10) Rule 1S- 2.0001, F.A.C.
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T81-1C Corr' OR .TIDE ORIGIN41- t 0CQMENT FILED
IN 111:_ 1;r "I_!.h• JE OFFICES. �t-1TiFIED,'ON THIS
APPOINTMENT OF CAMPAIGN TREASURER
a L :.`; CF' -.•
AND DESIGNATION OF CAMPAIGN
WITNESS 1' dY 111�,�D �;NIID C . (CiAL, -SEAL OF
DEPOSITORY FOR CANDIDATES
MIAmi S �E !tir .
(Section 106.021(1), F.S.)
BY:
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1 C ECK APPROPRIATE BOX(ES):
9 Initial Filing Form Re- filing Change: Treasurer /Deputy
of to ❑ Depository ❑ Office p Party
2. Nam of Candidate (in this order: First, Middle, Last)
3. Address (include rp�o�st office box or street, city, state, zip
-
code)/ � A /r
r
�; T"
%�
4. Telephone
5. E -mail addressf�
6. Office soug t (include district, circuit, group b r)
7. If a candidate for a nonpartisan office, check if
/�
/
m ' ��ti���[�
applicable:
0 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
Write -In e No Party Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer 3r epul - Treasurer
11. Mailing fAddress /
12. Teleph`o'ne
11 gity
14. Count
15. §Slpte
16. Zip Code
17./E -mail addre s
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address /f
21. City
22. County
J
23. State
24. Zip Code
UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR A POINTMENT OF CAMPAIGN TREASURER AND
DESIGNATION OF CAMPAIGN DEPOSITORY AND THAT THE FACTS
STA IN IY RE TRUE.
r
25. Date
a I�r
26. Signature of Candi t
X
27. Treasurer' Aetreptance of Appointment (fill in the blanks anti iec the ap ropriate block)
r
/✓�`, 1 f�4,
1, 1, do her a5pept'he appointment
(Plea R int or Type Name) J ;
lesignated ab we as: Campaign Treasurer ❑ Deputy Treasu r # !
1
ate Signature of Campaigplsie surer or Deputy Treasurer
DS -DE 9 (Revl 10/10) Rule 1S- 2.0001, F.A.C.