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DS-DE 84
STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) OFFICE USE ONLY 1 ~ /_ ~" C-~ - / q ~~h~~ ~ ~__~ //-- f. candidate for the office of ~~~~ ~/© ~- have received, read and understand the requirements of Chapter 106, Florida Statutes. ~ N Q -~ o ~ ~ ~~ r ~--- , ~ v: -~ ,,_ c: -•, rv •• t Signature of Candidate 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)