HomeMy WebLinkAboutDS DE 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:
®Write-in candidate
Candidate Oath
AUG 15 2024
City of Sebastian
City Clerk's Office
OFFICE USE ONLY
Name to appear on ballot: K P I i q d J I \knCi
Check box it two last names without hyphen. ❑ (Name cannot be changed after qualifying.)
Check box it name includes nickname. ❑ (For use of a nickname, you must complete the Nickname Affidavit on reverse side.)
I swear or affirm that I am a candidate for the nonpartisan office of _Sje_10n.Ck t1 ` l - lq Ci�.lnd I_.
(O ce (District #)
I am a qualified elector of li PICA i /1 fl 2 we.t— County, Florida
(Circuit N (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.
X n . �� (-M) y 53 -S 950 �ett�@vo}p
Signature o an i ate Telephone Number Email Address
-11�t_t� �Slat,cl ��• �ehaS+ian FL Address Address o Legal Residence City State ZIP Col
STATE OF FLORIDA
COUNTYOF Snd.jc,n RlVcr
Sworn to (or affirmed) and subscribed before me by meansof
online notarization ❑ so
�LOR physical presence Lf I
this 154t dayof Au(ytsr 20 2q
Personally Known 0 OR Produced Identification ❑
Type of Identification Produced:
j,qitureof otary Public
Type,.of,5tamp Commissioned Name of Notary Public below:
PUk/c
iSSIM
�RI2 20V
ASS/�OF
W M1Ni�°°
DS-DE 302NP (Eff. 10I2023)Rule'IS-2.0001, F.A.C.
onetic Spelling 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):
VGL—�e2 T-)1V--�c)r-,
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 I Entity
Affidavit of Nickname (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 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:
STATE OF FLORIDA
Signature of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by means
of online notarization ❑ OR physical presence ❑
this day of , . , 20 .
Personally Known ❑ OR Produced Identification ❑
Type of Identification Produced:
DS-DE 302NP (Eff. 10/2023) Rule 1S-2.0001, F.A.C.