DS-DE 84 S. Berke OFFICE USE ONLY
STATEMENT OF
CANDIDATE ` ' - 5n
(Section 106.023, F.S.) 2013 JUN 12 PM 1: 04
(Please Type) CITY CLEi,f;'S OF F iCr
.1 5`T'F-y- (SIG
candidate for the office of AA A-Y o 2 �
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
x ��Ll 3
i nature 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. 03/08)