HomeMy WebLinkAboutDSDE302NPCANDIDATE OATH RECFfV��
NONPARTISAN OFFICE kfl ,
(Do not use this form if a Judicial or School Board Candidate) City of
City C/ SodaV +.
Check box only if you are seeking to qualify as a �•/,
write-in candidate: C"c
❑ Write-in candidate OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
i, belly l O(On
(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 qualffying.
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 SebnS-�1 0Ln 01 �- J r nt 1 tnr't
(Office) (District #)
I am a qualified elector of In ci i ar % Q_ i V e_ v- 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): 114 Zq 3q 7 5
Phonetic spelling for audio ballot: Print name phonetically on the line below as you wish it to be pronounced on the audio
ballot as maybe used by persons with disabilities (see instructions on page 2 of this form): [Not applicable to write-in candidates.]
ICCL-Iee DIV—Cnri
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Signature of Ca U
date Telephone Number Email Address
21 altiir I.SleinH C+. Co(p�},44cLn FL 2958
Address City State ZIP Code
STATE OF FLORIDA
COUNTY OF J-11d I Q n k I Ue
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence
this /Ufi, day of A-119ta.�f .202 L.
Personally Known 10I OR Produced Idenfification ❑
Type of Identification Produced:
Ll✓.f�
Si ature of Notary Public
Pn ,Type, or Stamp Commissioned Name of Notary Public below:
y : aGe 27't343
DS-DE 302NP (Rev. 0812021) Imo\\,,\�Rule 1S-2.0001, F.A.C.