Simon Cruz DS-DE 84 Form
OFFICE USE ONLY
8T A TEMENT OF
CANDIDA TE
(Section 106.023, F.S.)
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candidate for the office of
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have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Signature of Candidate
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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) .
OS-DE 84 (Rev. 08/03)