This report applies to all candidates ELECTED to office who had loans
exceeding $500 in value, which were accepted and used for campaign
purposes within the 12 months preceding the election. All such loans
must be reported to the filing officer within 10 days after the candidate’s
election to office.
DS-DE 73 (Rev. 08/03)
CAMPAIGN LOANS
REPORT
(Section 106.075, F.S.)
(PLEASE TYPE)
___________________________________________________________________________
Full Name of Newly Elected Official
___________________________________________________________________________
Office
___________________________________________________________________________
Mailing Address
___________________________________________________________________________
City State Zip Code
I CERTIFY THAT I HAVE EXAMINED THIS REPORT
AND IT IS TRUE, CORRECT AND COMPLETE.
__________________________________________________________________________
Type or Print Name of Newly Elected Official
__________________________________________________________________________
Signature
X
OFFICE USE ONLY
