DS-DE 84 Kristen Rosen Gonzalez OFFICE USE ONLY
STATEMENT OF \_- 1)
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CANDIDATE 2015 HAY w 1 El i: 10
(Section 106.023, F.S.)
OFF ILE
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candidate for the office of 1 aunt (1n4vvtsr61T ;•
have been provided access to read and understand the requirements •
Chapter 106, Florida Statutes.
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. 5—{ 15
I S.•n.'ure o Candi.ate Da e
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(05/11)