Keane - DSDE 9 - Appt. Deputy Treasurer- Sean Keane 8-4-22APPOINTMENT OF CAMPAIGN TREASURER <' '
AND DESIGNATION OF CAMPAIGN
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
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(PLEASE PRINT OR TYPE)
NOTE: This form must be on file with the qualifying
officer before opening the campaign account. OFFICE USE ONLY
1. CHECK APPROPRIATE BOX(ES):
Initial Filing of Form Re -filing to Change: [3 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
SCG PC,,
, C ` G\ /1 e -code)
3is Sir,
4, Telephone
5. E-mail address
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6. Office sought (include district, circuit, group number)
7. If a candidate for a nonpartisan office, check if
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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 E] No Party Affiliation 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 Address
12. Telephone
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(�oK ) 52 ( f 7,11Y
13, City
14. County
15. State
16. Zip Code
17. E-mail address
18. 1 have designated the following bank as my Primary Depository Secondary Depository
19. Name of Bank
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20. Address
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22. County
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23. Stat
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24. Zip Code
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UNDER hNALTIES 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
Signature of
/26.
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27. reas Acceptance of Appointment (fill in the anks and check the appropriate block)
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I, do hereby accept the appointment
(Please Print or Type Name)
designated above as: Campaign Treasurer 1711 Deputy Treasurer
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Date Signature of Campaign Treasurer or Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S-2.0001, F.A.C.