HomeMy WebLinkAboutRe-filing of DS-DE 9 to add a Deputy Campaign Treasurer APPOINTMENT OF CAMPAIGN TREASURER DECIEIIVE
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES SEP 2 3 2015
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE) 71, LA:.
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
LI Initial Filing of Form Re-filing to Change: 0 Treasurer/Deputy Ei Depository El Office 0 Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address(include post office box or street, city, state, zip
v p(+W /1i1e M ►kl^_i 01 code) I9 Mott" **) (ZO40
4.Telephone 5. E-mail address 0_ 14. P E 4 i, j I"`
((- 1 ) Lt31 -AZSri ekE_-, 04-uPol, eifa4-✓.F/Z. .l.Cirydotkuel1. 0s +1h,toi3 - D
6. Office sought(include district, circuit, group number) 7. If a candidate for a nonpartisan office, check if
OAP E-- C4,-)!4,U 1E7Z A 1. C 1 T y to 1.11.Je-1 L applicable:
❑ 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
p Write-In El No Party Affiliation ® Party candidate.
9. I have appointed the following person to act as my ❑ Campaign Treasurer In Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
I C/4 42 �1-c 1, 14 R k I /
11. Mailing Address 12. Telephone
399 )4-001/4-k) .
( )
I13. City 14. County 15. State 16. Zip Code 17. E-mail address
C iPif- C)iulB-vL g1Z4-v/ !1 ) 1, )-.' _ e- /-04-27-Acv 8 0-F-L., 6Z 12, cin.
18. I have designated the following bank as my ®, Primary Depository El Secondary Depository
19. Name of Bank 20. Address � o 1 /'/, 4ii., rnt Jy, - ,4 L'L
IN L h LS r214-26 D ALA-,
1
21. City 22. County 23. State 24. Zip Code
C 14PL= 0-.4-N ME:12i ( V itt-R_A 3 .)--y)3
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 Candidate
- S Si> % X .�
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
I, C-/¢j/}-(Z k L C. 1+y4-(Z j !-, L y , do hereby accept the appointment
(Please Print or Type Name)
designated above as: D Campaign Treasurer CH Deputy Treasurer.
q- aTS - 1 X ejw_tc, I\ )
Date Signature of Campaign Treasurer eputy Treasurer
DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.