HomeMy WebLinkAboutDSDE302NPCANDIDATE OATH — R
NONPARTISAN OFFICE FCEii,�
(Do not use this form if a Judicial or School Board Candidate) Ci41jr C S'
Check box only9 to qualify as a C', Of
if You are seeking
write-in candidate:
❑ Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
hyphen, check boxEl. (See page 2 - Compound Last Names). No change can be made after the end of qualifying.
Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of C y %y
(Oce) (District #)
I am a qualified elector of /AID1,4 /z/ A) VP_ (, 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.
Candidate's Florida Voter Registration Number (located on your voter information card): ,Gf% Y
Phonetic spelling for audio ballot: Print 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 2 of this form): [Not applicable to write-in candidates.]
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Signature of Candi a Telephone Number Email Address
%6 OPS MA R sr S Ile 111'15�r/AN >`Z 9S�
Address City StateT/ /�ZIP Code
STATE OF FLORIDA �� �`^Q m
Si0fiture of Notary Public
COUNTY OF If7 d % Ct i7 i(t i/e r PrinYType, or Stamp Commissioned Name of Notary Public below.
Swom to oAr, affirmed) and subscribed before me this z,R
dayof 20 �9
Personally Known. or Produced Identilication,
Type of identification Produced:
DS -DE 302NP (Rev. 11117)
Rule 1S-20001, F.A.C.