DSDE- 9 CharlesAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
02-15 34A 23-219CE DL
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
02-14-23P 12 1 1 RC VD
(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):
14 Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
J
code) c
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, t � d'Q S l.- 3'139
4. Telephone
5. E-mail address
L"'' �u �Qs(2cync ��
(3o� ) 3� _ai
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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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COva
applicable:
❑ My intent is to run as a Write -In candidate.
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8. If a candidate for al 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 PZCampaign Treasurer ❑ Deputy Treasurer
10. Na a of Treasurer or Deputy Treasurer
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11. Mailing Address
12. Telephone
c 00 � 0 �� S e
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13. City
14. County
15. State
16. Zip Code
17. E-mail address v
e
I F 3% 3 f
1-vme rle: /S-3 f/�/kc
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
W E1.1. WZ 60V
21. City
22. County L23.
State
24. Zip Code
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. Signatu o didate
2C:�_l l �®4� 3
x
27. Treasurer's Acceptance of Appointment (fill in the auks and check the appropriate block)
1,6�'V'L i , do hereby accept the appointment
(Please Print or Type Name)
designated above as: [3, Campaign Treasurer i]e uty Treasurep
a NU X
' Signa T easurer or Deputy Treasurer
ate re of mpaign
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.