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Home My WebLink AboutDSDE302NPCANDIDATE 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--]Wrhe-in candidate Candidate Oath JUL 3 1 2025 City of Sebastian City Clerk's office OFFICE USE ONLY Name to appear on ballot: 7-G RR / / 1V C (5;1 N Check box if two last names without hyphen. ❑ (Name cannot be changed after qualifying.) Check box H name includes nickname. /M (For use of a nickname, you must complete the Nickname Affidavit on reverse slde.) I swear or affirm that I am a candidate for the nonpartisan office of ! _ (7 Y Ooawcf L //rt lYI f�jL=/2 r (Office) (District N ; I am a qualified elector of -Z7U I A A) 911v6iz ebt" I 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 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, 1 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. /� [Zis) -7a3- 433a X'/�,�,-re�r�Y`I� (7�a) 3�0- i/a C6)Nti�GnaRtL,cc)m Sltufefure of Candidate Telephone Number Email Address /7�{7f %i%6L�EQ 4)p S�,3Rs%!ifltJ �!� �21 (i" Address of Legal Residence City S ate - ZIP ode STATE OF FLORIDA II COUNTYOF �y.diwq �it� Sworn to (or affirmed) and subscribed before me by means of online notarization ❑ OR physical presence this 2 (a day of I iIvi-t/ 207115. Personally Known ❑ OR Produced Identification Type of Identification Produced: ,` �Y,JM S t C( r Signature of Notary Public Print, Type, or Stamp Commissioned Name of Notary Public below: 071 t YLfL•<- Coin Y Ug io ••• �� CHEYENNE CAIN Commission # HH 580509 +rFp' Expires August 11, 2028 F Fioe� DS-DE 302NP (Eff. 10/2023) Rule 1S-2.0001, F.A.C. —PhonedB7354Wng 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): 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 chapter106. Amount I Entity Affidavit of Nickname (Only required If using nickname for the ballot.) My legal name is Tfi?43AA 0:t GA2 L Al(-G) IJ N I am over the age of eighteen (18) and the contents of this affidavit are true and correct. My nickname is TER P Y . 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 COUNTY OF S NN lavx (';✓ Un Sworn to (or affirmed) and subscribed before me by means of online notarization ❑ OR physical presence, this Z� day of )thy-e' 20 . Personally Known ❑ OR Produced Identification II Type of Identification Produced: ,1 / ot'rt4,?? L�Czfte--, Signature of Notary Public Print, Ty e, or Stamp Commissioned Name of Notary Public below: (�,gbkr-t Co•V\ 24�r P�aQ� CHEYENNE CAIN Commission#HH 580509 •+,•"�e� Expires August 11, 2028 orr� DS-DE 302NP (Eff. 10/2023) Rule 1S-2.0001, F.A.C. Phonetic spelling for the audio ballot (not required for qualifying purposes): Print the name phonetically on t t%D�p�otBCaRyou wish Il to be pronounced on the audio ballot as may be used by persons with disabilities (see instructions on page 3 o O�7St1q, 4t fec PYlul'j i��,v ' Ce Sfaternpot of Outstanding Fines, Fees or Pgnq#j9 Pursuant to Section 99.021(f)(d), F,S., each candidate, whether a party candidate, a candidate with no party affilladon, 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. tl 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 - En.0ty - Affidavit of Nickname (only. required If using nickname for the ballot.) My legal name is T G12_0 AAJCI= E_A9(MiCG) A At . I am over the age of eighteen (18) and the contents of this affidavit are true and correct. My nickname is %'Rp V . I am generally known by this nickname or have used it as part of my legal name. 1 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 COUNTY OF Tvvd two✓tom v / V Signature of Notary Public Print. Ty e, or Stamp Commissioned Name of Notary Public below. Sworn to (or affirmed) and subscribed before me by means cw lm. (' Caps^ of online notarization El OR physical presence 4, thisy� day of �111W'� , PO )f7 poµY'�41' CHEVENNECAIN Commission#HH580509 Personally Known ❑ OR Produced Id9nUhC@tlon. 'facrus EYpiresAugost11,Z028 Type of identification Produced: DS•DE 302NP (Eff. 1012023) Rule 13•2,0001, F.A.C.