DS DE 84 M. ShapiroOFFICE USE ONLY ~ ~,
STATEMENT OF =~
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(Section 106.023, F.S.) j ._.w acs
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candidate for the office of t~ C G t r
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Signature of Candi to Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Campaign Treasurer and Designation of Campaign Depository is filed. Willful
failure to ale this form is a first degree misdemeanor and a civil violation of the Campaign
Financing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Florida
Statutes).
DS-DE 84 (Rev. 08!03)