DS-DE 84STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please Type)
OFFICE USE ONLY
candidate for the office of
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
X
S~lrrat'~r,J' 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), Flodda
Statutes).
DS-DE 84 (Rev. 08/03)