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HomeMy WebLinkAboutJulie Fishman - Designation of Campaign Treasurer - DS-DE 9 (2)All. rl APPOINTMENT OF CAMPAIGN TREASURER AND DESIGNATION OF CAMPAIGN DEPOSITORY FOR CANDIDATES nil MAY 15 AM 10: 59 (Section 106.021(1), F.S.) (PLEASE PRINT OR TYPE) RECEIVED TY OF IA!!* *�,C 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: ©x x 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 JULIE FISHMAN code) r -� --Ivoc�-)-o lU 4. Telephone E-mail address 6. Office sought (include district, circuit, 6roup number) 7. If a candidate for a nonpartisan office, check if applicable: 0 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 ❑ Party candidate. 9. 1 have appointed the following person to act as my Campaign Treasurer ❑ Deputy Treasurer 10. Name of Treasurer or Deputy Treasurer MITCHELL B. HALLER 11. Mailing Address 12. Telephone 8751 W. BROWARD BLVD., SUITE 410 ( 954 ) 424-9666 13. City 14. County 15. State 16. Zip Code 17. E-mail address PLANTATION BROWARD FL 33324 mhaller@klaubergoldman.com 18. 1 have designated the following bank as my Primary Depository ❑ Secondary Depository 19. Name of Bank 20. Address TD BANK 1800 N. PINE ISLAND ROAD 21. City 22. County 23. State 24. Zip Code PLANTATION BROWARD FLORIDA 33322 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 5/15/2019 26. Signature of Candidate \\, 27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block) MITCHELL B. HALLER 1 do hereby accept the appointment (Please Print or Type Name) designated above as: Campaign Treasurer Dep y Treasurer. 5/15/2019 X Date Signature of Ca paign Treasurer or Deputy Treasurer DS-DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.