HomeMy WebLinkAboutDSDE84STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
OFFICE USE ONLY
RECEIVED
JUL ' S
ity
?D
CC, of se asl?.
rks Once
i, � P 1 I', I-)t'�-Orl ,
candidate for the office of C v i Ccxknc i � ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
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Si ature of Candidate
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Daie
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)