DSDE-9 BellinsonAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
01-26-23P 7 2: 13 RC VD
(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. CHECK APPROPRIATE BOX(ES):
® Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate(in(in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
P nd e, w I `�, , W11I)SIbIq
code) q 20 rl„ N E L4*?
Shores, I
4. Telephone
5. E-mail address
(3�5 ) 91-1100-0 Rog
Nt be, 11loS011e 1C../0q
,) .Low ; 3 51,35
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
c j� � applicable:
MI (�.I(Vl ► �� Q S I I I 1p CQ(,(,n C
cJ 1 ❑ 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. Name of Treasurer or Deputy Treasurer
11, Mailing Address
qRD5 14+�
1ph
3 05 g r 6 A 0 � 0
13. City
M [arn I S hofCisMiami
T4, County
Dads
15. State 16. Zip Code
3;3139
17. E-mail address
Amy eAl fhson �rC(� �d•
18. 1 have designated the following bank as my J, Primary Depository ❑ Secondary Depository
19. Name of Bank
—a
20. Address
$ E 2nd Av�-
CA S r �
21.City
Khank �h�rPs
22. County
YYl► d�
23. State
24, Zip1 Code
JJ �.]
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. SZfff Candidate _
i 2� 202-3 x
27. Treasurer's Acceptance of Appointment (fill in th blanks and check the appropriate block)
1. rew [_) I I n S O / f1I , do hereby accept the appointment
(Please Print or Type Name)
r
designated above as Campaign Treasurer ❑ Deputy Treasurer.
! 2- x 1
Date Sj nature of Campaign Treasurer or Deputy Treasurer
M
DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.