HomeMy WebLinkAboutDSDE 302NPCANDIDATE OATH
RECEIVED
NONPARTISAN OFFICE
(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:
F]Wrile-in candidate
Candidate Oath
AUG 16 2023
City of Sebastian
City Clerk's Office
OFFICE USE ONLY
Name for Ballot: C1KU7-0(?i��2 / /e t:�O"T / /(ACA
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 �' / r
�(/(}ffice) (District #)
; I am a qualified elector of �� V f 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.
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S' ature,afegn—didate Telephone Number Email Address
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Address of Legal Residence city Slate ZIP Code
STATE OF FLORIDA
COUNTYOF in� rig, )QlVer
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ /iORphysical presence Rr
this�dayof AkQlksf ,20Z3.
J
-y
Personally Known L�'I OR Produced Identification ❑
Type of Identification Produced:
gnature of Notary Public
int, Type, or Stamp Commissioned Name of Notary Public below:
W COMMISSION
EXPIRES 2-28-2027
DS-DE 302NP (Eff. _/2023) N',M.:;EOF 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. 11 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
Entitv
Affidavit of Nickname
Is -
nC/ty Of �U73
/(y CierRDastian
r1 D Oe
RECFi1 /�
400
My legal name is �%%�121 STQ r� (2 9, Al ~f I am over the age of eighteen (18) and the
contents of this affidavit are true and correct.
0 My nickname is V ( S . 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 a politic ogan or otherwise associate me with a cause or issue, or that is obscene or profane.
Signaturl _
STA16A 11'r RIDA
COUNTY OF inrj n, Ptve,r
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence 12r
this 16� day of //tkjt"S ,2023.
Personally Known ✓ ORProduced Identification ❑
Type of Identification Produced:
gniure of Notary Public
Print, TyAor Stamp Commissioned Name of Notary Public below:
MY COMMISSION
EXPIRES 2-28-2027
DS-DE 302NP (Eff. _/2023) Rule 1S-2.0001, F.A.C.