HomeMy WebLinkAboutDSDE25 Redacted & Qualifying ReceiptCANDIDATE OATH -
NONPARTISAN OFFICE
(Not for use by Judicial or
School Board Candidates)
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OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
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(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT `— NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of 5� as �� a tj Z;/Ij
(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 1 will support the Constitution of the United States and the Constitution of the
State of Florida.
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Signature of Candidate
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Telephone Number
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city State
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Email Address
ZIP
Candidate's Florida Voter Registration Number (located on your voter information card):
* 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):
STATE OF FL03MA
RWCOUNTY OF .f
Sworn to (or affirmed) and subscribed before me this day of
Personally Known: � or SALLY A. MAIO
M Commission !# FF 153543 Signature of Nota
Produced Identification: Expires October 5, 2018 Print, Type, or S�
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Type of Identification Produced:
20
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p Commissioned Name of Notary Public
DS -DE 25 (Rev. 5/11) Rule 1S-2.0001, F.A.C.
CITY OF SEBASTIAN
FINANCE DEPARTMENT RECEIPT 9939
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Name All Cash
Date ;'Check #i%
❑ Credit
Amount Paid
001001 208001 Sales Tax
001001 220000 Security Deposit -
001501362100 Taxable Rent -
001501362150 Non -Taxable Rent -
450010 369900 Airport Badge
001501 329500 Alarm Permits
001001218010 CobraServe
001501 354100 Code Enforcement Fines
001501 347557 Community Center Revenue
001501341920 Copies
001501 369900 Miscellaneous Revenue
001501 359000 Other Fines/Forfeitures
001501 351140 Parking Citation
001501 342100 Police Security Services
Total Paid `~
Initials
White - Dept. of Origin - Yellow - Finance - Pink - Applicant