HomeMy WebLinkAboutDSDE 302NP ANDIDATE OATH rsti-tivtu
NONPARTISAN OFFICE AUG 0 4 2023
(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: City of Sebastian
City Clerk's Office
❑Write-in candidate
OFFICE USE ONLY
Candidate Oath
Name for Ballot: �o+-� / / d ✓� / 9 �1 /
First Middle Name/Initial/and/or/Nickname Last Name Suffix
(See reverse side for Nickname Affidavit.)
swear or affirm that I am a candidate for the nonpartisan office of �L Lt qS ( ) rj Y) (// Lr'CLf1'l �-I .
(Ofi/I / (District #)
I am a qualified elector of �n ajice) )9 0 � V � � 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 of 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.
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(f)(d), F.S.).
YES, 1 Do NO, I Do Not —Z
If you do, you must also specify the amount owed and each entity that levied the same on the reverse side.
X �W��
Signature of Candi ate�r
Address of Legal esidence
STATE OF FLORIDA
COUNTY OF t/IJ(6tpl PLU "
(7?1 /"-m cj�grI Z�>4),Aq 1, / It) M
Telephonen Number - l/ Email Addr_e� ����
2W4)-t f)w!r� _3
City State ZIP Code
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence
this q+11day off ALIc. U,5 t- , 20 Z
I �l J.
Personally Known OR Produced Identification ❑
Type of Identification Produced:
Vg nature of Notary Public
int, Type, or,,%",Pommissioned Name of Notary Public below:
MY COMMISSION
EXPIRES 2-28-2027
DS-DE 302NP (Eff. _/2023) '111 7pfy M� Rule 1S-2.0001, F.A.C.
RECEIVED
Statement of Outstanding Fines, Fees, or Penalties AUG 0 4 2023
Pursuant to Section 99.021(1)(d), F.S., each candidate, whether a party candidate, a candidate with raiill trmmw,F qn
write-in candidate, shall, at the time of subscribing to the oath or affirmation, state in writing whethq j op{�og'el)fte
outstanding fines, fees, or penalties that cumulatively exceed $250 for any violations of s. 8, Art. 11 of the�S ` cta e�ons{Itution, 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 Entity
/�/� <Affidavit of Nickname
My legal name is /1 r) L r--1 / C � lJq { �Q Yl I am over the age of eighteen (18) and the
contents of this affidavit are tn{e and cortec
My nickname is ��" 1/)h 6 /„I C .4 1 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 p itical ogo sociate me with a cause or issue, or that is obscene or profane.
Signature:
STATE OF FLORIDA
COUNTY OF' I_n,&icLm P,tt12X
Sworn to (or affirmed) and subscribed before me by means of
online'' notarization ❑O/RR physical presence L7
this 7 day of
J
Personally Known 9 OR
Type of Identification Produced:
Produced Identification ❑
$ nature of Notary Public
Print,
Ty , or Stamp Commissioned Name of Notary Public below:
W COMLIS"
EXPIRES 2-28.2027
DS-DE 302NP (Eff. _/2023) Rule 1S-2.0001, F.A.C.