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STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
AUG 18 1013
City of Sebastian
City Clerk's Office
candidate for the office of Sebastian City COL1nril
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X sut ti �1i uc
Signature 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 (05111)