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
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OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
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(Print name above as you wish it fo ap ear 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 , ,a ()
, ; I am a qualified elector of
(Circuit #) (Group or Seat #)
ffi1ice)
IA t64U) VQ,
(District #)
County, Florida;
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): ) I U's 3 8 1 -:� -I
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ballot as,ptay be used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.]
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Signaturgldf Candi ate -
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Address t
STATE OF FLORIDA
COUNTY OF i Air qcl\ VG< VZIr
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Telephone Number Email A dress/
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city State ZIP Code
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence Z
this ZD" day of Y"fu j u S f- , 20 Z ( .
Personally KnownER" OR Produced Identification ❑
Type of Identification Produced:
Ignature of Notary Public
rnt, Type, or Stamp Commissioned Name of Notary Public below.
DS-DE 302NP (Rev. 0512021) ��LjA,r,'8(,C-st'ptEdaaa Rule 1S-2.0001, F.A.C.