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DS-DE 84 KarltonOFFICE USE ONLY STATEMENT OF CANDIDATE (Section 106.023, F.S.) (Please Type) (, :!~ '/~LT4 candidate for the office of C~ ~ ~ ~. c°~ .~:~_ ~,n ~~ have received, read and understand the requirements of Chapter 106, Florida Statutes. nature of Candidate .~-~ ~9 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). -~a t;? ,r .~ _~,..r ~ i D5-DE 84 (Rev. 03!08)