Hill- DSDE 9- Deputy Treasurer- Della Hill 3-10-17DS -DE 9 (Rev.10110) 1 Rule 15-2.0001, KA.U.
Received
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN
2017
DEPOSITORY FOR CANDIDATES
MAR 1 0
(Section 106.021(1), F.S.)
(PLEASE PRINT OR TYPE)
Office of Cry Clerk
NOTE: This form must be on file with the qualifying
officer before opening the campaign account.
OFFICE USE ONLY
1. C CK APPROPRIATE BOX(ES):
Lff Initial Filing of Farm Refiling to Change: ❑ 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
James Kdt
cod3T2 'f+h `✓freet
AytC tiC U A t,.1u't R, :Wjz>
!l I
4. Telephone
5. E-mail address
(qo ) x{•2'158
e� a{1oo.ccm
6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
cov m17 i 5510r'7 r er eoz+'A
applicable:
❑ My intent is to run as a Write -In candidate.
8. If a candidate for a gaW2an office, check block and fill in name of party as applicable: My intent is to run as a
❑ Wdle-InPady Affiliation ❑ Party candidate.
9. 1 have appointed the following person to act as my ❑ Campaign Treasurer DeputyTreasurer
10. Name of Treasurer o e Tre85ur
.Dila Hil oI ree,
11. Mailing Address 1 112.
Telephone
312 1 k sty -eek-
Ho )24(o -I543
13. City ,q
tic pe0.
14. County
puvo
15. State
F
16. Zip Code
3zz33
17. E-mail address
inde1l4tble`{5(0Ct 00-Cvrr9
18.1 have designated the following bank as my Primary Depository ❑ Secondary Depository
19. Name of Bank
20. Address
8ealoris
MI5 9�ci eer
City
hoepimlw
22. County
23. State
24. Zip Code
�J�C
,]loco,
32
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. Sig re of C I
X
27. Treasurer's Acceptance of Appointmen ill the blanks and check the appropriate block)
1, De((a L + M , do hereby accept the appointment
(Please Print or Type Name)
Deputy
designated above as: ❑ Campaign Treasurer Q Treasurer.
Date ignatu Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev.10110) 1 Rule 15-2.0001, KA.U.