HomeMy WebLinkAboutDS-DE 25DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C.
IrECEJVED
CANDIDATE OATH —
AUG 22
NONPARTISAN OFFICE
Z013
City of
City Cle Sebastian
f
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT' -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of & /y 6, .." % , ,
(office) (district #)
I am a qualified elector of County, Florida;
(circuit #) (group or seat #)
I am qualified 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.
X /� (' 72) Ili y7��
me
Signature of Cand' date Telephone Number Em it AdId6r9fis
�_r�LJ .✓�} /tS'GG _ " ? %G�/ S
Address City- State ZIP Code
Candidate's Florida Voter Registration Number (located on your voter information card): 10 V&6 S-16 /
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons
with disabilities (see instructions on page 2 of this form):
STATE OF FLO IDA
COUNTY OF.! /i��
Sworn to (or affirmed) and subscribed before me this day o , 20
�
Personally Known: or
Signature of otary Public
Produced Identification: Print, Typ r S Public
Commission lion #l� E 024350
Type of Identification Produced: -
o' Expires October 5, 2014
Bonded Thru Troy Farn Insurance 809 - 385=1019
DS -DE 25 (Rev. 5/11) Rule 1S- 2.0001, F.A.C.