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DS-DE 84 Herman
STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) OFFICE USE ONLY R~C'1= I~~I~ 2009 SEP I I PSI 3= 58 CITY GLE~~~"~`C GE= i~ ils~_ candidate for the office of ~Ii9 ©~ ~F J71~./7/~ ~~j9G~L ; have received, read and understand the requirements of Chapter 106, Florida Statutes. X /r- nature of Candidate 09 -JJ - a~ 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 file 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. 03/08)