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Home My WebLink AboutDSDE 302NPCANDIDATE OATH 9ECEIVEi NONPARTISAN OFFICE AUG 18 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 �Wrile-in candidate OFFICE USE ONLY Candidate Oath Name for Ballot: aw lcw ci/' / f I f l a'. C / First Middle Name/Initial/and/or/Nickname I Last Name Suffix (See reverse side for Nickname Affidavit.) I swear or affirm that I am a candidate for the nonpartisan office of G f 4,y l o ulvt -tf (Office) f(^/ (District #) I am a qualified elector of /mod (! N 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 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(1)(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. 4�i S gnatureot bandIts 117 LA I - �vAr-t-Dt Address of T al Residence STATE OF FLORIDA (771 `I 1 3 — M 3 j-)Q Nito5 ' l 1J. �J �yt�M •/td Telephone Number Email Ad ess l/ J r St(ae�('f7'ar of ICL 3 Z?C) 5 ity State ZIP Code COUNTY OF rtAd 1 C v\ R I ve r Sworn to (or affirmed) and subscribed before me by means of online notarization ❑ OR physical presence this 14, day olff Au cr II s' -f , 20 Z3 . Personally Known L_I OR Produced Identification ❑ Type of Identification Produced: irigntn��o�.6jjdP�la� . ature of Notary Public Type, or Stamp Commissioned Name of Notary Public below: MY COMMISSION EXPIRES 2-2&2027 DS-DE 302NP (Eff. /2023) Rule 1S-2.0001, F.A.C. Statement of Outstanding Fines, Fees, or Penalties Pursuant to Section 99.021(1)(d), F.S., each candidate, whether a party candidate, a candidate with no party affiliation, or a 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. font Entity N0N�� 1 4, �. G.6 Fc 0. ergs p sr�� \x/ 00 Affidavit of Nickname My legal name is , � t VA14✓1 � r . I am over the age of eighteen (18) and the contents of this affidavitaretrue and correct. My nickname is V V I, ( dv— . 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[ itical'slogan or otherwise associate me with a cause or issue, or that is obscene or profane. Sign ature: w)/\�`'J_rl / U STATE OF FLORIDr A COUNTYOFJ�3a, .t/trn KIVkr Sworn to (or affirmed) and subscribed before me by means of online notarization ❑ OR physical presence 9 this day of /Z L9 uS , 20 Z3. Personally Known OR Produced Identification ❑ Type of Identification Produced: ga nature o o arjPublic Print, Stamp Commissioned Name of Notary Public below: Ptz o MY COMMISSION EXPIRES 2-28-2027 DS-DE 302NP (Eff. _12023) Rule 1S-2.0001, F.A.C. CANDIDATE OATH RECEJVEO NONPARTISAN OFFICE AUG (Do not use this form if a Judicial or School Board Candidate) 5 1013 Check box only if you are seeking to qualify as a write-in candidate: C tl t.y Of Seba 7Wrile-in candidate Y ClerkS Of /Ce OFFICE USE ONLY Candidate Oath ..�I ��t / / r /i Air Namefor Ballot. r1VA(�2� I L' I `�//�(R[.tt l ��Nk-I— First Middle Name/Initial/and/or Icknam Last Name Suffix (See reverse side for Nickname t.) I swear or affirm that I am a candidate for the nonpartisan office of l ( cduK ice 1 (Office) b (District #) I am a qualified elector of - 4 d a It t Ve I/' 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 slate, 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 Slates and the Constitution of the Stale 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. 99.02 1 (1)(d), F.S.J. 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. x (7X)713-113 -D4AW5b^i*Xr�a"l. Cofer SignatureeCandld:� Telephone Number / il A dress .0 Ad ress of Lega esitlence City State �I 2rP Cotle STATE OF FLORIDA COUNTY OF 7�5`^Cl Gtn � - Y Sworn to (or affirmed) and subscribed before me by means of online notarization ❑ /� OR physical presence this _ day of 44-0 .20 Personally Known ❑ OR Produced Identification Type of Identification Produced " Print. Type. c(r S}dmp Commissignecj Name of Notary Public below: �y <G DEBORAHJACOBSON Notary Public, State of Rodda Comrrussion0 HH 406517 MY Comm. expires June 05. 2027 DS-DE 302NP (Eff. 12023) Rule 1 S-2.0001, F.A.C. Statement of Outstanding Fines, Fees, or Penalties Pursuant to Section 99.021(1)(d), F.S., each candidate, whether a party candidate, a candidate with no party affiliation, or a 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. A ount n Entity ' I '" 15 %ty Of \ city ale `Setiq Office Affidavit of Nickname My legal name is�N/f te,11% Ll if � l _ N'C..`(I (f Q Kt< I am over the age of eighteen (18) and the contents of this afidavil are true and correct. I `( My nickname is J ii �% . 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 parson, conslitu a political slogan or otherwise associate me with a cause or issue, or that is obscene or profane. Signature: STATE OF FLO IDA ` COUNTY OFbF7�: n.V.`1� 1j Signature of Note blic Print. Type, or Stamp Commissi ne Name of Notary Public below: Sworn to (or affirmed) and subscribed before me by means of online notarization ❑ OR physical presence .�i ,`s DEBOHAHJACOBSON Notary Public, State of Florida '\ this day of , 20�� Commissionil HH 406517 My comm. expires June 05, 2027 Personally Known ❑ OR Produced Identification�� Type of Identification Produced: P-7 _ I(,ll DS-DE 302NP (Eff. _12023) Rule 1S-2.0001, F.A.C.