DS-DE 84 David P. Hundleyr
OFFICE USE ONLY
STATEMENT OF
CANDIDATE
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(Section 106.023, F.S.) 2012 OCT 2 9 PH 5: 01
(Please print or type) C I T Y C �_,�,;. 0 F F i C r
candidate for the office of o- �A W\. l ePC---0 ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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Signature of Can ate
di 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(05/11)