HomeMy WebLinkAboutJulie Fishman - Designation of Campaign Treasurer - DS-DE 9APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
7019 KAY -7 PM 3' Q )
(Section 106.021(1), F.S.)
RECEIVED
(PLEASE PRINT OR TYPE)
CiTY OF TA IDAC
CIT'r CI._r I":
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. HECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: Treasurer/Deputy 0 Depository Office Party
2. Name of Candidate (in this order: First, Middle, Last)
3. Address (include post office box or street, city, state, zip
4. Telephone _
5. E-mail address
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
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
Write -In No Party Affiliation Party candidate.
9. 1 have appointed the following person to act as my Campaign Treasurer [a-' Deputy Treasurer
10. Name of TreasUreyL.DepuTreasurer
11. Mailing Address
12. Telephone
13. City
�--
14. County
15 State
16. Zip Code
7. E-mail address �Q
18. 1 have designated the following bank as my JR- Primary Depository Secondary Depository
19. Name of Bank
20. Address
21. City
22. County
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. Signature of Candidate
27. \ Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
I, ` J v�� (tt� �`���(V�C ; , do hereby accept the appointment
(Please Print or Type Name)
designated above as: Ej Campaign Treas rer Deputy Treasurer.
C\c X
l!Ilate Signature Campaign Treasurer Deputy Treasurer
of or
DS-DE 9 (Rev. 10110) Rule 1S-2.0001, F.A.C.