HomeMy WebLinkAboutDS DE 302NPCANDIDATE OATH RECEIVED
NONPARTISAN OFFICE JUL 3 j 2024
(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
Write-in candidate City Clerk's Office
OFFICE USE ONLY
Candidate Oath
Name to appear on ballot: -�: A -V-�,rs a A
Check box if two last names without hyphen. ❑ (Name cannot be changed after qualifying.)
Check box if name includes nickname. ❑ (For use of a nickname, you must complete the Nickname Affidavit on reverse :ride.)
I swear or affirm that I am a candidate for the nonpartisan office of S e�'f3T�Z^ `% sf G)UAC- n
(n(Office) (District #)
I am a qualified elector of 1'WC� t.� 2� tl�. 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 stale, 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 (a. 99.021(1)(d), F.S.).
YES, 1 Do NO, 1 Do Not ✓
If you do, you must also specify the amount owed and each entity that levied the same on the reverse side.
X i� �/ ( YES-J Intoc��grt;l.cp �.
Signature of Can r ate Telephone Number E ail Address
Address of Legal Residence State ZIP Code
STATE OF FLORIDA
COUNTY OF 1-Ad i aV\ �,t V t C
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence El
this 3 ST day of _T_tk V , 20 Z—t .
,
Personally KnownET OR Produced Identification ❑
Type of Identification Produced:
nature of Notary Public
nt, Type, or Stamp Commissioned Name of Notary Public below:
my COMMISSION
E)(PIRES 2-28 V27
DS-DE 302NP (Eff. 10/2023) "'� /SSt;;;;v:;;;a �';o°`� Rule 1S-2.0001, F.A.C.
one c pe ing of Name
Phonetic spelling for the audio ballot (not required for qualifying purposes): Print the name phonetically on the line below as you
wish it to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 3 of this form):
y0 CS
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.
Amount Entity
Affidavit of Jickname (Only required if using nickname for the ballot.)
My legal name is
affidavit are true and correct.
I am over the age of eighteen (18) and the contents of this
My nickname is I a _�).. I a . 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 of Candidate: `""V
STATE OF FLORIDA
COUNTYOF fr\ct aln �Ivt'r
Sworn to (or affirmed) and subscribed before me by means
of online notarization ❑ OR physical presence L1
this 3 (S r day of J LA ( 4 20 Z4 .
Personally Known ED' OR Produced Identification ❑
Type of Identification Produced:
Signature of Notary Public
Pn Stature
or Stamp Commissioned Name of Notary Public below:
MY COMMISSION
EXPIRES 2-28-2027
DS-DE 302NP (Eff. 10/2023) irS�ONUMe...'III Rule 1S-2.0001, F.A.C.