Glasser -DSDE9- Change of Depository-Treas- D.Glasser 3-2-17DS -DE 9 (Rev. Willi) Rule 1S-2.0001, F.A.C.
Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES MAR 2 2017
Section 106.021(1), F.S.)
PLEASE PRINT OR TYPE) Office or city clerk
NOTE: This form must be on file with the qualifying
officer before oDenina the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: Trilasurer/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
code)
z
4. Telephone
0'{ )y 2 (,26.
ail addresstdOfficesought (inc,circuit, group number) 7. If a candidate for a nonpartisan office, check If
6
I S" e <
applicable:
My intent is to run as a Wdte-In candidate.
8. If a candidate for aap rtisan office, check block and fill In name of party as applicable: My intent is to run as a
Write -In F] No Party Affiliation 0 Party candidate.
9_. 1 have appointed the following person to act as my [ Campaign Treasurer [:] Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Addresg
0kc,5')r
12. Telephone
330 0 009 )3U
13. City
IIF, 1'C
14. County
AV4
15. State
L
16. Zip Code
32233
1 17. E-mail address
W14
18. 1 have designated the following bank as my r Primary Depository Secondary Depository
19. Name of Bank 20. Address
d- 03)
21. City 22. Co y, 23. State 24. Zip Code
y U uc l I' Z 33
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,91' Candidate
I I -) X
27. Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1, Da.: S y G Lass er , do hereby accept the appointment
Please Print or Type Name)
designated above as: Campaign TreasurerDeputyTreasurer.
Date Signatureo Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. Willi) Rule 1S-2.0001, F.A.C.