Smith- Statement of Candidate- 6-3-15 OFFICE USE ONLY
STATEMENT Received
CANDIDATE
JUN 3 2015
(Section 106 . 023, F .S . )
(Please print or type) Office of City Clerk
I , JAMES (JI &C j ` SM1 �CI ,
candidate for the office of Cok I t 551 OMB. °° cc/ Aar
have been provided access to read and understand the requirements of
Chapter 106 , Florida Statutes .
. ,
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'signature of Candidate 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 )