Norris -DSDE84- Statement of Candidate 1-24-22STATEMENT OF
CANDIDATE
(Section 106.023, F.S.)
(Please print or type)
OEFIcE USE 0
•
JAN 2 4 2022
1, ba:\Vach JC)e2`S
candidate for the office of0,A(1(3of e.aA- 1
have been provided access to read and understand the requirements of
Chapter 106, Florida Statutes.
X i 112,-(1247L
ignature'of ' . didate 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)