DS-DE 84OFFICE USE ONLY
STATEIVIENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please Type)
I, ~ t~ ~~, ~~ ~ ~
candidate for the office of
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v~
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have received~ read and understand the requirements of Chapter 106,
Florida StatutES.
X
Si nature of Candidate
:-
Date
Each candidate must file a statement with the qualifying officer within 10 days after the
Appointment of Cam~iaign Treasurer and Designation of Campaign Depository is filed. Willful
feilure to file this form is a first degree misdemeanor and a civil violation of the Campaign
Ftnancing Act which may result in a fine of up to $1,000, (ss. 106.19(1)(c), 106.265(1), Flarida
Statutes).
D3-DB S4 (R~v. 08103)