DS-DE 84 J. Libbin 09STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please Type)
candidate for the office of /`~~'.~r~,` ~~~~~ ~ t-y ~c~~, s ,~~,,~ ~'~o~~/
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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ii~~~
Date
Sie)'fi~ture of Candidate
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. 03/08)