HomeMy WebLinkAboutDSDE 302NPCANDIDATE OATH -
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you
write-in candidate:
❑ Write-in candidate
are seeking to qualify as a
RF�EfV�O
1��� ?
ty
C Y C/f eba , an
OFFICE USE ONLY
— andidate Oath
(Section 99.021(1)(a), F tatutes)
I, L �S
(Print name above as yoh wish it to appear on the ballot. If your last name C�sf'�ts 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 �l �./ eafy
(Office) (District #)
I am a qualified elector of dICA yt 2x t /�_/ 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): I Z[) 16. 1_ Z0_1
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): [Notapplicable to write-in candidates.]
IBC I t n� i� . 11S
r�
%C ((Al) %Og �DIS� �I�LWSA� VTi cjle-i
Sign ure o nd Telephone Number y mail Address
72` 54,W4
Address i
STATE OF FLORIDA
COUNTY OF L ICH Qn R t Val'
City
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence LT
this 2-5 4�I, day lof! r 3 LtS f. 20 Z�.
t
Personally Known I � OR Produced Identification ❑
Type of Identification Produced:
State
3 z y7<V
ZIP Code
6nature of Notary Public
nt, Type, or Stamp Commissioned Name of Notary Public, below:
14
OGG InSN
DS-DE 302NP (Rev. 05/2021) 1/J12R/C STAISII� CW Rule 1S-2.0001, F.A.C.