DSDE-9 Walsh RevisedAPPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
0 3 -10-2 3P U 3: 08 R C VD 11A
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: ❑C 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) 5 NE IVI S-f
aly`� sk D ryes, L 31 3
-co401V
4. Telephone
r7uya
5. E-mail address
(74)O-tgI
yVVa(S(g1810000K
6. Office sought (include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
applicable:
�/ 9ZJ C19,A � o I ❑ 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
U 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 p4er s
11. MailingAddress '^ � ` s� O �C� �
5sNE `01 1� S� � F(T4)ae(-
12. Telephone
:7y�
-
13. City r
b0 -'ej
14. County
'�•`kal t — Pa �
15. State
L r'J,33
16. Zip Code
r,3
17. E-mai address
W4 @ J �`G o R siC rec -
18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank 20. Address
� o � ort" A C q�,q I N a� d Div M�a �Sa�C-s
21. City 11
22. Counter
23. 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. S' Candid I A J
ck to 'a, 2-� X t, V"IV
27. Treasurer's tance of Appointment (fill in the blanks and check the appropriate block)
rAcce
, S
I, lS • U , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasur Deputy Treasurer.
Date Signature of Campaign Treasurer or Deputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.