DS-DE 84 Mohammad R. Islam 2017STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
OFFICE USE ONLY
2017. MAY -8 PM 4: 00
CITY IA "AK'S OFFICE
'KO RANAME-- 9-API aU
m
ti
candidate for the office of c -r Gy
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
I II
Signature of Candidate 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 (05/11)