DS-DE 84 Urquiza OFFICE USE ONLY
STATEMENT OF RFc 'I,I,
CANDIDATE
(Section 106.023, F.S.) 201 FEB +4 PM 12• 51
(Please Type) CITY CLERKS OFF ICE
k77.5 A, A4 dR4Ui
h
candidate for the office of Co M M ; 5,10,j ew - �d� 7_
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
VAt///
Signature of nd'c 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 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)