Ford - DSDE9 - Appointment of Campaign Treasurer and Designation of Campaign - Deputy Treasurer - C. Ford 5-1-24APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
/ RECEIVED /
(Section 106.021(1), F.S.)
MAY 0 12024
(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the filing officer before
opening the campaign account.
OFFICE USE ONLY
1. CH K APPROPRIATE BOX(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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AJ144,�t a&Kt6 C 32z 33
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4. Telephone:
5. Candidate's Voter Registration #:
6. Email Address
(day) 333 �S '
6
Q 657 1C o
(not required for qualifying purposes)
7. Office Sought (include district, circuit, group, or seat #):
8. If a candidate for a1 e, check the box
if applicable:
M d J� a T ;
❑ I intend to run as a Write -In Candidate.
9. If a candidate foroffice, check the box and fill in the name of the party as applicable: I intend to run as a
❑ Write -In Candidate. No P rty Affiliation Candidate. ❑ Party candidate.
10. 1 have appointed the following person to act as my: ❑ Campaign Treasurer Deputy Treasurer
11. Name of Tr asurer or Deputy Treasurer:
12. Telephone:
13. Email Address:
a� .r
(gay ) .33354
14. Mailing Address:
15. City:
16. State:
17. Zip Code:
777,
_5'36
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18. 1 have designated the following bank as my (check appropriate box): Primary Depository ❑ Secondary Depository
19. Name of Bank: n
20. Address -
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21. City:((
22. County:
23.
24. Zip Code:
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Cate:
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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. Signat of Ca idate:
25. Date:
�1112y
X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check t e appropriate box)
I, do hereby accept the appointment designated above as:
(Please Print or Type Name)
❑ Campaign Treasurer. D%Deputy Treasurer.
Sign e f Ca paign asurer or Deputy Treasurer
28. Date: '
12YN
129.
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DS -DE 9 (Rev. 09123) Rule 1S-2.0001, F.A.C.
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