DSDE-9 CastellanosAPPOINTMENT 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)4r:CK APPROPRIATE BOX(ES):
E' 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
code)
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4. Telephon 5. E-mail address / ptr1 S 1f Z 31 c�
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6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
appl9ca
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
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11. Mailing Address
12. Telephone
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13, City
14. County
15. State
16. Zip Code
1 . E-mail address
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18. 1 have designated the following bank as my Primary Depository [`] Secondary Depository
19. Name of Bank 20. Address
21. City
22. County
23. State
24. Zip Code
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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 ATED IN IT ARE TRUE.
25. Date 26. Signa andi
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27. -Keasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I. V"' c'�z51 , do hereby accept the appointment
(Please Print or Type Name)
designated above as: L"J Campaign Treasurer ❑ D' y Treasurer
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Date nature of Campaign Treasurer or Deputy Treasurer
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DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.