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DS-DE 84 Luis Salom Group IV STATEMENT OF CANDIDATE RECEfVED OFFICE US N~ PH ~: II CITY CLERw'(': 0 ' T\ v FF ICE (Section 106.023, F.S.) (Please Type) I, Luis Salom candidate for the office of Commission Group IV have received, read and understand the requirements of Chapter 106, Florida Statutes. x 1/05/07 Date ~ Signature of Candidate 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. 08103)