Glasser - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign Amended- E. Glasser - Treasurer 2-7-24APPOINTMENT OF CAMPAIGN TREASURER
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AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
FEB 7 2024
(Section 106.021(1), F.S.)
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(PLEASE PRINT OR TYPE)
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NOTE: This form must be on file with the filing officer before
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opening the campaign account.
OF USE ONLY
1. CHECK APPROPRIATE B X(ES):
❑ Initial Filing of Form Re-filing to Change: ❑ Treasurer/Deputy Depository ❑ Office ❑ Party
2. Name of Candidate (in this order: First, Middle, Last):
3. Address (include PO Box or Street, City, State, Zip Code):
(Please Print or Type Name)
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4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address:
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(not required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
8. If a candidate fora nonpartisan office, check the box
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if applicable:
❑ I intend to run as a Write-In Candidate.
9. If a candidate for partosan office, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write-In Candidate. ❑ No Parry Affiliation Candidate. ❑ Party candidate.
10. 1 have appointed the following person to act as my: Campaign Treasurer ❑ Deputy Treasurer
11. Name of Treasurer or Deputy Treasurer:
12. Telephone:
13. Email Address:
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14. Mailing Address:
15. City:
16. Sta .
17. Zip Code:
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18. 1 have designated the following bank as my (check appropriate box): aPrimary Depository ❑ Secondary Depository
19. ame of Bank:
20. Address:
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21. City:
22. County:
23. State:
24. Zip Code:
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UNDER PENALTIES OF PERJURY, I DECLARE THAT I HAVE READ THE FOREGOING FORM FOR THE APPOINTMENT OF THE
CAMPAIGN TREASURER AND DESIGNATION OF THE CAMPAIGN DEPOSITORY AND THAT THE FACTS STATED IN IT ARE TRUE.
26. Signature of Candidate:
25. Date: 2(-7 2
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27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate box)
I, \ 1 GI 55 e— t� do hereby accept the appointment designated above as:
(Please Print or Type Name)
Campaign Treasurer. ❑ Deputy Treasurer.
28. Date: - (
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29. Signaftre of Campaign Treasurer or Deputy Treasurer
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DS-DE 9 (Rev. 09/23) Rule 1S-2.0001, F.A.C.