DS-DE 84
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06 JUL 25 M.;III: 4 3
_._~:;.~) ,'FF ICE OFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please Type)
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candidate for the office of If 1tlP11 '&;kh C I.; (;I-I;'f/IJ/ /Vi C; ftJp V ;
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Signature of Candidate
?J-;;;6 6
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)