HomeMy WebLinkAboutDSDE 302NP ANDIDATE 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
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OFFICE USE ONLY
Candidate Oath
y. Q (Section 99.021(1)(a), Florida Statutes)
—AW/GJS/f�). tidr
(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 r;9 y e,�," ye-'
((5ffice) (District #)
I am a qualified elector of 7 �:4�/ ,oel'veX 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): /17�/Z / %D rl
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.]
Signer of Candidate Telephone Number Email Address
/G3 S /� �/ _,)
Address City State ZIP code
STATE OF FLORIDA
COUNTYOF fn,-JIQn P,(Ver
Sworn to (or affirmed) and subscribed before me by means of
online notarization ElOR physical presence li of
this I -l"" day of Att Je 0 S t 20 2 II .
Personally Known E OR Produced Identification ❑
Type of Identification Produced:
DS-DE 302NP (Rev. 0512021)
4S' ature of Notary Public
P , Type, or Stamp Commissioned Name of Notary Public below:
Rule 1S-2.0001, F.A.C.