Statement of Candidate
STATEMENT OF
CANDIDATE
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09 ~UG 12 P1'I12: t.O
(Section 106.023. F.S.)
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candidate for the office of ...h-1. "::? ~
have received, read and understand the requirements of Chapter 106,
Florida Statutes.
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Date
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).
OS-DE 84 (Rev. 03/08)