HomeMy Public PortalAboutStatement of CandidateOFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
C) yr
I, 1C4- L (cu\it_ v
candidate for the office of
CIMrMc`sS1Nsec C1(' cS�r��� 5��� ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
x caA._
Signature of Candidate
olopo
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)
ERKDri
! t4 3. r._F_