HomeMy WebLinkAboutDSDE302NP ANDIDATE OATH
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
�r4�c Name to appear on ballot: n ,S
RECEIVED
AUG - y 2025
tY of Seb
City astian
Y Clerk S Office
OFFICE USE ONLY
Check box if 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 ell,/ ✓Z,14W
(Office) (District #)
I am a qualified elector offCounty, 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 Slates 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 i./
If you do, you must also specify the amount owed and each entity that levied the same on the reverse side.
ature of Candidate Telephone Num Signber mall Address
A d h21'L egalkesidence ny ate Z P Code
STATE OF FLORIDA
_6al(_. tC11hA.
COUNTY OF 1h d I a R I VtY 4itii
ture of Notary �ubiic
ype, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presencelI am' 'PjSEWICC/�
L� ,."�E •.......•„ q�'6�.,,
this T day of /Ni9 US% 2025. : • ao C •. ';
l� J
Personally Known OR Produced Identification ❑ I.& COMMISSION
Type of Identification Produced:
cxPIRES 2-28-2027
a- -
OF
DS DE 302NP (Eff.10/2023)TEF�� t" Rule 1S-2.0001, F.A.C.
Ronetic spelling ot 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 �f'cJ>[ 4�i[lC Olfin.�Ac /) , Y�iS I am over the age of eighteen (18) and the contents of this
affidavit are true and correct.
My nickname is 'g*z'Q /C . 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 Candidaa, _,-
STATE OF FLORIDA
COUNTYOF, MC 'ati RtV2r-
Sworn to (or affirmed) and subscribed before me by means/
of online notarization ❑ OR physical presence lJ
this T -" day of AIL /yLGCS } 20 Z5 .
Personally Known E�r OR Produced Identification ❑
Type of Identification Produced:
DS-DE 302NP (Eff. 1012023)
i�Nota
W�(-d�YrlA.
nature Public
Print, Type, or Stamp commissioned Name of Notary Public below:
�oZPRY PUglicu., ��''
MY COMMISSION
Ey,PIRES 2-28.2027
Qi¢
o �srq�OFF��Q'�'ry $
'/sS�ONNUT�E�:rr Rule 1S-2.0001, F.A.C.