DS-DE 84 Michael Góngora
STATEMENT OF
CANDIDATE
RECEIVEO
OFFICE USE ONL 2: 05
CITY CLERK'S OFF ICF
(Section 106.023, F.S.)
(Please Type)
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I, !y1L[,i01 GU~(f~ . . . '
candidate for the office of fL11 afh~ ik~ G A 1V1;~ Q~ G(t.u'f Jl-;
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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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 ).
DS-DE 84 (Rev. 08/03)