HomeMy Public PortalAboutStatement of CandidateOFFICE USE ONLY
STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
i, N) code e �r�.v^tt.\o r'IvNr3e C
candidate for the office of Dr\cav t C'‘ CIMvvti sss% 0 r-) .-Ic-r\ci. 3 ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
Signa ure of Candidate
(2 73421
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 (05/1 I )