DS-DE 84 Joy Malakoff STATEMENT OF OFFICE USE ONLY
CANDIDATE 2016 JUN _0 0 9: 20
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(Section 106.023, F.S.)
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(Please print or type)
candidate for the office of M c1 , w��►�'s�io�r r � ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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Signature of Ca ate tate
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(05111)
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