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DSDE-9 Meltz
cTeTF OF Ft nRine COUNTY OF MIAMIL J E I. HEREBY CERTIFY THAT THIS DOCUMENT IS A APPOINTMENT OF CAMPAIGN TREASURER TRUE COPY OF THE ORIGINAL DOCUMENT FILED IN THE VILLAGE OFFICES OF MIAMI SHORES. AND DESIGNATION OF CAMPAIGN CERTIFIED ON THIS JBILDAY OF FEBRUARY DEPOSITORY FOR CANDIDATES � ESS MY HAND AND OFFICIAL SEAL OF (Section 106.021(1), F.S.) MIAMI SHO I LAGE (PLEASE PRINT OR TYPE) _ YSABELY R DRIGUEZ, CIVIC NOTE: This form must be on file with the qualifying VIL GE CLERK officer before opening -the campaign account. I 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 this order. First, Middle, Last) 3. Address (include post office box or street, city, state, zip Jonathan Meltz code) 157 NE 104 Street 4. Telephone 5. E-mail address Miami Shores, FL 33138 (786 ) 269-5630 jmeltz@meltziaw.com 6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if Miami Shores Village Council applicable: ❑ My intent is to run as a Write -In candidate. 8. If a candidate fora partisan office, check block and fill In name of party as applicable: My intent is to run as a ❑ Write -In ❑ No Party Affiliation ❑ Parry candidate. 9. 1 have appointed the following person to act as my © Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer Jonathan Meltz 11. Mailing Address 12. Telephone 157 NE 104 Street ( 786 ) 269-5630 13. City 14. County 15. State 16. Zip Code 17. E-mail address Miami Shores Miami -Dade IFL 33138 1 Jmeltz0meltz1aw.com 18. 1 have designated the following bank as my ® Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address Bank of America 9499 N.E. Second Avenue 21. City 22. County 23. State 24. Zip Code Miami Shores Miami -Dade FL 33138 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. Signature of Candidate 2/3/21 x 27 Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) 1 Jonathan Meltz _ , do hereby accept the appointment (Please Print or Type Name) designated above as: 0 Campaign Treasurer ❑ Deputy Treasurer. x wnm�_A� 2/3/21 _ Date _ Signature of Campaign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.