Ray- DSDE 9- Appt. Treasurer- Terri Ray 2-18-20 D E c, '
APPOINTMENT OF CAMPAIGN TREASURER r
AND DESIGNATION OF CAMPAIGN FEB 1 8 2020
DEPOSITORY FOR CANDIDATES
(Section 106.021(1), F.S.)
(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: CI Treasurer/Deputy CI Depository EI Office Party
2. Name of Candidate(in this order: First, Middle, Last) 3. Address (include post office box or street, city, state, zip
code)
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4.Telephone 5. E-mail address Pt ICPM i..t G L Th F L
(91)L1 ' S) c�s� C roec,atc�v� J 33
6.Office sought(include district, circuit,group number) 7. If a candidate for a nonpartisan office,check if
applicable:
1" \C.yC)r /i tc.' i- g Ccs L_IM 0 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
Ei Write-In El No Party Affiliation ID Party candidate.
9. I have appointed the following person to act as my Ei Campaign Treasurer Deputy Treasurer
10. Name of Treasurer or Deputy Treasurer
11. Mailing Address 12.Telephone
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13. City 14. County 15. State 16.Zip Code 17. E-mail address
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18. I have designated the following bank as my NI Primary Depository El Secondary Depository
19. Name of Bank 20.Address
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21. City 22. County 23. State 24.Zip Code
Rear, ( c- FL, 3 L()
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. ure of Candidate
FC, , X
27. Treasurer's Acceptance of Appointment(fill in the blanks and check the appropriate block)
cr'r ,do hereby accept the appointment
(Please Print or Type Name)
designated above as: ® Campaign Treasurer El Deputy Treasurer
bate of Campaign Treasurer or De y Treasurer
DS-DE 9(Rev. 10/10) Rule 1S-2.0001, F.A.C.