DS-DE 84STATEMENT OF CANDIDATE
(Section 106.023, F.S.)
(Please Type)
candidate for the office of ~,/~ o,,%~--~ ~
have received, read and understand the requirements of Chapter 106,
Flodda Statutes.
v 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 {Rev. 8/99)