HomeMy WebLinkAboutDSDE 302NPCANDIDATE 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
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2020
City M Seb astin
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OFFICE USE ONLY
r(Section 99.021(1 xa), 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 name.; 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, tp name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of
(Office) (District #)
;I am a qualified elector of �f/%� r p N ft , ✓e e- County, Florida;
(Circuit #) (Group or Seat F)
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 H ith the office
I seek; and I have resigned from any office from which t am required to resign pursuant to Section 99.012, Florda 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): ZO ��(I4 J -7
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronouncec on the audio
ballot as may be used by persons with disabilities (see instructions on page 2 of this form): (Not applicable to write-iq candidates.)
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Signature of Candidate Telephone Number Email Address
Address I City n StaleyF1P C�oc
STATE OF FLOWDq G IhJ!
l r i�' YI� Signature of Notary Public
COUNTY O ��,J 1h_ V C. tPrint Type, or Stamp Commissioned Name of Notary Puts is belaav:.
Swom t r affirmed) a ubscrib d before me this 20 7 1 a ,Nly Patricia Ann Wiles
day of tr' .20 . < NOTARY PUBLIC
STATE OF FLORIDA
�(/ ? Comm# GG268677
PersoraAy Nno•.vn. _ or Prodyeed identjfipa0on: p E 19 Expires 10/17/2022
Type of Identification Produced. ,lJ/1tJ.� / -
DS-DE 302NP (Rev. 11117) Rule 1S-2.0001, F.A.C.