DS-DE 84 June E. Savage 2017OFFICE USE ONLY
STATEMENT OF RE,CEtVED
CANDIDATE --------i-------------l----20ll-AYG_...3-~M-~L1-3--, __
(Section 106.023, F.S.)
CITY Of MIAMI BEACH
(Please print or type) OFflCJ~ OF THE CrrY curnK
1, xJW!e h0eJL ~ra_q=-,
candidate for the office of --~ ~~ ~ /!Jmc( ii.
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
I ®ate
, 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)