DS-DE 84 RECEIVED
CANDIDATe_ JU~ ~ /llli0.' 13
STATEMENT
OF
i]tTY ,.,LEITH S OFFICE
(Section 106.023, F.S.)
(Please Type)
candidate for the office of /~le~i
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
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. 8199)