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HomeMy WebLinkAboutDSDE302NPCANDIDATE OATH — NONPARTISAN OFFICE (Do not use this form if a Judicial or School Board Candidate) Check box only if you are seeking to qualify as a write-in candidate: ❑ Write-in candidate Candidate Oath (Section 99.021(1)(a), Florida Statutes) 4 r�p19 eyCP r aeb35U3Pe CIG OFFICE USE ONLY (Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no hyphen, check box ❑. (See page 2 - Compound Last Names). No change can be made after the end of qualifying. Although a write-in candidate's name is not printed on the ballot, the name name must be printed above for oath purposes.) am a candidate for the nonpartisan office of 1) v Cmu' 1 f Q&_Null (office) (District #) ; I am a qualified elector of County, Florida; (Circuff if) (Group or Seat 9) 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 1 seek; and 1 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. Candidate's Florida Voter Registration Number (located on your voter information card): ' 10 I `U / 9 v 19 Phonetic spelling for audio ballot: Print name phonetically on the fine below as you wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.] A 1 -tai I-©-vim-No GAIING . Sionature of Candidate Telephone Number Email Address p Address City allotary�C �stat ZIP Cod e jhA_vnn SiafeSTATE OF FLORIDA Pgc COUNTYOF et/tr r Type, or stamp commissioned Name of Notary Public below. Sworn to (or affirmed) and subscrib(e)d before me this day of (,L) it'_ Ir b ey , 20 (! �9 moo; Personally Knoxm. t/ or Produced Identification. __ Yr j s • • Type of identification Produced: T e r ; ••; py K`4j 11�N DS -DE 302NP (Rev. 71/17) 9��� Y 11'�ji Rule 1S-20001, F.A.C.