HomeMy WebLinkAboutDS DE 302NP ANDIDATE OATH RECEIVEC
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate) AUG 0 tt 2023
Check box only if you are seeking to qualify as a write-in
candidate:
City of Sebastian
Write-in candidate City Clerk's Office
OFFICE USE ONLY
Candidate Oath
Name for Ballot: r'�,�✓�. _ _ / - l r r�� /
First Middle Name/Initial/and/or/Nickname Last Name Suffix
(See reverse side for Nickname Affidavit.)
I swear or affirm that I am a candidate for the nonpartisan office of
(Office) (District #)
I am a qualified elector of •1�I :.-n/ ;`ri!3Z County, Florida;
(Circuit #) (Group or Seat #)
I am a qualified elector 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 Stales and the Constitution of the State of Florida.
Statement of Outstanding Fines, Fees, or Penalties
I owe outstanding fines, fees, or penalties, that cumulatively exceed $250, for ethics or campaign finance violations (s. 99.021(l)(d), F.S.).
YES, I Do NO, I Do Not
If you do, you must also specify the amount owed and each entity that levied the same on the reverse side.
7 4-1 i8 r�iyfi3u3�y �s�L�s�o:�
Signature of Candidate Telephone Number ,,/ Email Address f
Address o Legal esi ante Cary �/ late 1 Code
STATE OF FLORIDA jn�
turNoCOUNTY OF ]i/i i LLvt kivev e of tary Public
Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by means of",y,
tiTfE W/°�yro
online notarization ❑ OR physical presence I-1 or -S ...•:ipRYp(y • `.r1S°�,
this qkln dayof /-f.,LtCQLDSP 20Z.3. 3 ••aO �C•'•
J ?
Personally Knownl�I, ❑ (� I �7 OR Produced Identifcation E:XPIRES2-28-2027 _-
Type of Identification Produced: v Q�;dx, s
DS-DE 302NP (Eff. _12023) "+,w y;�;;;o N' ,.��� Rule 1S-2.0001, F.A.C.
RECEIVED
AUG 0 4 2023
Statement of Outstanding Fines, Fees, or Penalties
City of Sebastian
Pursuant to Section 99.021(1)(d), F.S., each candidate, whether a party candidate, a candidate with no pa&affi@f#11kq EiDffICE
write-in candidate, shall, at the time of subscribing to the oath or affirmation, state in writing whether he or she owes any
outstanding fines, fees, or penalties that cumulatively exceed $250 for any violations of s. 8, Art. II of the State Constitution, the
Code of Ethics for Public Officers and Employees under part III of chapter 112, any local ethics ordinance governing standards
of conduct and disclosure requirements, or chapter 106.
Amount
�otl'C
Ent1ty
Affidavit of Nickname
My legal name isZ 6 _iv%S . I am over the age of eighteen (18) and the
contents of this affidavit are true and correct.
My nickname is 1',�'o/J .-r-..,. . I am generally known by this nickname or have used
it as part of my legal name. I have not created the nickname to mislead voters. My nickname does not imply I am some other
person, constitute a political slogan or otherwise associate me with a cause or issue, or that is obscene or profane.
Signature:
STATE OF FLORIDA
COUNTYOF rnJI'OVl KIJe(
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ ORa�
, physical presence
this q+� /y
day of / t K3 I.f S f• , 20? 3.
Personally Known EZ OR Produced Identification ❑
Type of Identification Produced:
nature of Notaryublic
Print, Typ or Stamp Commissioned Name of Notary Public below:
MY COMMISSION
EXPIRES 2-284027
P
tq�For Fl,�:
DS-DE 302NP (Eff. _12023) Rule 1S-2.0001, F.A.C.