DS-DE 84 Elsa Urquiza
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OFFICE USE ONLY
STATEMENT. OF CANDIDATE
(Section 106~023, F.S.)
(Please Type)
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candidate for the office of
CO;VI /l1/sS /'0 n e/L
have received, read and understand the requirements of- Chapter 106,
Florida Statutes.
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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. 08/03)
65