HomeMy WebLinkAboutDSDE 302NPCANDIDATE OATH —
NONPARTISAN OFFICE RE�FI�FD
(Do not use this form if a Judicial or School Board Candidate) tip
Check box only if you are seeking to qualify as a �,il Cit yOfSebas
write-in candidate: Clerk- flan
Office
❑ Write-in candidate
OFFICE USE ONLY
Candidate Oath
,) (Section 99.021(1)(a), Florida Statutes)
(Print name above as you wish it to ap r 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 "Se jnn "`man C/171 C-Ooyir_r' /
(Office) �/ (District #)
I am a qualified elector of �y� { n n 2i oec U1_ 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): Zl el O - � ' 7 / 49
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.]
3 g tu� an date
Address
STATE OF FLORIDA
COUNTY OF Y1012l0-n 1,IUCLI-�
(71-V aaA/-_791n
Telephone Number
city
Sworn to (or affirmed) and subscribed before me by [0/physical or
El online presence this day of /"/uj- ,20aQ
Personally Known: f or Produced Identification:
Type of Identification Produced:
ail Address
st§le
('��J�`/-��'/\�, ZIP Code
r /✓
Signature f Notary Public
Print, Type, or tamp Commissioned Name of Notary Public below:
FSonded
4.,. JOHN T. DALE
Notary PublicState of rlodda
Commission # GG 236994
fl�, My Comm, Expires Jul 10, 2022
through National Notary Assn.
DS-DE 302NP (Rev. 04/20) Rule I S-2.0001, F.A.C.