DS-DE 84sTATEMENT OF CANDIDATI ECEIVED
03 FEEl 2 7 AH I0: I~'/
(Section 106.023, F.S.)
(Please Type) CiTY CLERK'S OFF ICE
candidate for the office of ~,~L ~,~P_~ ~..~'[-h~ ~~-C£/b,~V" ~'~P.~
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
X
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
failur~ to fi;e 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)