HomeMy WebLinkAboutDSDE25 OathCANDIDATE OATH -
NONPARTISAN OFFICE
(Not for use by Judicial or
School Board Candidates)
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
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(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON)
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OFFICE USE ONLY
BALLOT' — NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of ; courxc-A >
(office) (district #)
I am a qualified elector of �,, �„� �; ��� County, Florida;
(circuit #) (group or seat #)
I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or
elected; I have qualified for no other public office in the state, the term of which office or any part thereof runs
concurrent with the office I seek; and I have resigned from any office from which I am required to resign pursuant to
Section 99.012, Florida Statutes; and I will support the Constitution of the United States and the Constitution of the
State of Florida. --I
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Signature of Candidate Telephone Number Email Address
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Address City State ZIP Code
Candidate's Florida Voter Registration Number (located on your voter information card): 10 y 4 !(7 J 'q O
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons
with disabilities (see instructions on page 2 of this form):
A -n/- - � - E -E - Of
STATE OF FLO IDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me this0100'r day of
Personally Known: or
r,.•`�' SALLY A. MAIO
Produced Identification: =.g :�► Commission # FF 153543
i Expires October 5, 2018
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Type of Identification Produced:
20�.
Signatur(F of N ry Public
Print, Type, o Stamp Commissioned Name of Notary Public
DS -DE 25 (Rev. 5111) Rule 1S-2.0001, F.A.C.