Rojas, Miryam- 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 opening the campaign account.
OFFICE USE ONLY
1. C ECK APPROPRIATE BOX(ES):
Initial Filing of Form Re- filing to Change: ❑ Treasurer /Deputy ❑ Depository [] Office ❑ Party
2.. Name of (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
/ /Candidate
t" i R Af-,x {) _,PA S
code) /�5,� 53Y Af E q S.� s Tp�.
I �'l /'14M 1 s F 3 31,3 '.
4. Teleph ne
5. E -mail address
(_,qrvtiRyPfRC 'v CA
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
�,
/h e in &✓r ,/
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. Nam //e of Treasurer o(r� �Deputy Treasurer
A1llFwvr c] [7P7LE
11. Mailing Address
53q NE q5, rT ST M t Rfh I SH-DPESJ rL , 33l3
12. Telephone
(���) -j j_j-
13. City
MI li( i X1 12
14. County
�iF1�11- �•
15. State
F�
16. Zip Code
3 313 R
17. E -mail address GLt / LA"
q
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
�r o E724'CA- 9499 )VE Zn� /4ve-
21. City
222.. County
23. State
24. Zip Code
Nl i A UVII i i� fZE S
t�
I �-'l 1 I�t m I -- IJ1� to
FL
13'N38
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. Signat f Ca idate
t.
27. Treasurer's Acceptance of Appointment ( in the b s and check t appropriate block)
1. M 4M K do hereby accept the appointment
(Please Print or Type Name)
designated above as: ❑ Campaign Treasurer Deputy Treasurer.
DI 9 X
Date Sign ur 16f Ca p `gn Tr surer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 15- 2.0001, F.A.G.