DSDE-9 LewisAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
0L-24-23P 0 3 48 R C V D
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. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: ❑ Treasurer/Deputy ❑ Depository ❑ Office ❑ Party
2. Name ofCandidate(in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
code) 9� v I4 - C✓ ' ! /� J��
4. Telephone
5. E-mail address [11rt-
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
applicable:
1
❑ My intent is to run as a Write -In candidate.
H-ti! � S Gu r��
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 ❑ Party candidate.
9. 1 have appointed the following person to act as my ® Campaign Treasurer ❑ Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
6_. -L r - cr IN t-S
11. Mailing Address
12. Telephone
q y� ,tt _ u: l AUe
(�jb�) �12 SfO C
13. City 14. County
A���R� l� j<C
15. State
r— (
16. Zip Code
'� eJZ
17. E-mail address
I L P_✓•s' V-169
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
At K o A -IL, r f) c
21. City
tLa
22. County f&^1
23. State'
24. Zip Code
/4-1 I ! IL
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. Signatpre of- nciidat -
27. Treasurer's Acceptance of Appointment (fill f he blanks and check the appropriate block)
1 L Wf,�, / ,., ` � , do hereby accept the appointment
(Please Print or Type Name)
designated above as Campaign Treasurer ❑ dre _
;Deput
2y-
Date __5ig ature-of ampaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule i5-z.uuui, r.A.l;.