DS-DE 84 Saul Gross
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STATEMENT OF
CANDIDATE
RECEIVED
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CITY CLERK'S OFF ICE
(Section 106.023, F.S.)
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cand;date tor the office of Jl1.y" 5.j M,rw,;, &.J,
have received, read and understand the requiremen s of Chapter 106,
Florida Statutes,
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Signature of Candidate
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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 )(e), 106.265(1), Florida
Statutes).
OS-DE 84 (Rev. 08/03)