DS-DE 84 Group VI
STATEMENT OF
CANDIDATE
RECEIVED
200
C I r9FF[ICE ~SE ON L Y
CltRK S OFF ICE
(Section 106.023, F.S.)
(Please Type)
E!sA JdQ.J;~
candidate for the office of ~ 0/?J??7 i 5'5 ;" 0 ~ c r:
I.
S2 vj? ~
"
have received. read and understand the requirements of Chapter 106.
Florida Statutes.
x
a
r/~7
I ate
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)