Daugherty, Jonathan- Statement of CandidateOFFICE USE ONLY
STATEMENT OF Received
CANDIDATE
(Section 106.023, F.S.) JAN 2 5 2013
(Please print or type)
I, J Un e-k-tl^c-N
Office of City Clerk
candidate for the office of C , C.O/11/1/l , SS / erSPA4 ;
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X
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)