HomeMy WebLinkAboutDSDE 302NPCANDIDATE OATH —
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate) 4,� /CeiLeO
Check box only if you are seeking to qualify as a �ryyofS,
write-in candidate: C% , ehasl _
❑ Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
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(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 must be printed above for oath purposes.)
am a candidate for the nonpartisan office of CA Ty l Qt)/j C t t_� I ,
(Office) (District #)
I am a qualified elector of jZfdik,L 06VO-ry 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.
Candidate's Florida Voter Registration Number (located on your voter information card): t i!5-4 I l o83
Phonetic spelling for audio ballot: Print name phonetically on the line 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.]
G t i /VaaQ k e 4—
X 0�11 C�'� (1170 7 ` i /lP� �t�Cwi+aR i ��0. • (W
Signature of Candidate Telephone Number Email Address
Address City State // ZIP Code
STATE OF FLORIDA W.< l (QlVrt/I
jSnTat.u.re of Notary PubliCOUNTY OF �d (an 16 ✓ C. l ,y, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by 9 physical or �F`O\
❑ online presence this L day of ILSf , 20 ZU .��y�.' '1
J l
Personally Known: V or Produced Identification: *: •••
M272363.
Type of Identification Produced:dW
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DS-DE 302NP (Rev. 04I20) S a�ISTAM tt��� Rule 1S-2.0001, F.A.C.
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