DS-DE 84 Raphael Herman
STATEMENT OF
CANDIDATE
- ,/.. .
OFFICE USE ONLY
2001 JAN 23 PM~: 13
CITY CLEHK'S OFF ICt
(Section 106.023, F.S.)
(Please Type)
I, RAP H A E 1-
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candidate for the office of
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Signature of Candidate
:rAA/U~R.Y 231 2 (')07
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).
OS-DE 84 (Rev. 08/03)