Victor Norfus -; >_r v' n
APPOINTMENT OF CAMPAIGN TREASURER
AND DESIGNATION OF CAMPAIGN 14 FEB 10 PM 1: 59
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 ❑ Treasurer /Deputy ❑ Depository p Office ❑ Party
2 Name of Candidate (in this order Fir t, Middle, Last) 3 Address (include post office box or street, city, state, zip
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code)
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4 Telephone 5 E -mail address 1 v
(S /) (uG o ric co- (32Q(tmcz i / (c9/1 3(1 iel) �-e0 C , � , ``
7 TL 7
6 Office sought (include district, circuit, group number) 7 If a candidate for a nonpartisan office, check if
l ,; C/ C , / / � applicable:
9/5-74,-/ c -7 " `� (c' m tit !s j , e ,.0• -- El 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
El Write -In ❑ No Party Affiliation ❑ Party candidate
A I have appointed the following person to act as my El Campaign Treasurer ❑ Deputy Treasurer
.0 � N e of Treasurer or Deputy Treasurer
i''C,!cr , 4/ r`:: J5
11 Mailing Address 12, Telephone
/ A6 ,--2/ 4 IT; 4,, n-- t /L (Ls-0 ) 6 0 / - c'--2 9G
13 City 14 County 15 State 16 Zip Code 17 E -mail address
C. /: / /r) i J4 /`- L 3s 4/.S S' Y� c( 362 c-__)))-0‘c»/ ( fora
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18 1 have designated the following bank as my si Primary Depository ❑ Secondary Depository
19 Name of Bank PP- cL ° 20 Address
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g I �r, �,x a �. �, CO ��r�J G / f (- c�,� L� / Y c'��rX�� Est ° /7U - _
X21 City 22 County 23 State 24 Zip Code
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 of Candidate . //
-97/0/1 , /
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27 Treasurer's Acceptance of Appointment (fill in the blanks and check the appropriate block)
1 , K(Ici-- //" / j4)- -- / S , do hereby accept the appointment
(Please Print or Type Name)
'esignated above as Campaign Treasurer 2 Deputy Treasurer
I s2 / 707 x / i ,/ .
Date Signature of c mpaign Trea er o Deputy Treasurer
DS -DE 9 (Rev. 10/10) Rule 1S- 2.0001, F.A.C.