HomeMy WebLinkAboutDSDE302NPCANDIDATE OATH — A�
NONPARTISAN OFFICE c
(Do not use this form if a Judicial or School Board Candidate) ClC
Check box only if you are seeking to qualify as a io SP �Q9
write-in candidate:
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❑ Write-in candidate °o
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
I , A W k4VI �k _ (i t t- C_ t iA� w1 S
(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 box ❑. (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 ,.i%rSwrtt+d1 CL -14
(Office) (District#)
;I am a qualified electorof ,-p�.� tIA-rJ �.L�l"C� County, Florida;
(Circuit N (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;
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): 44 - 1 (3 A .' 3 17
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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X C ('-leu -77-11 J l b-1 l V (4 M 1, �Q T
Signatureof �de Telephone Number Email Address
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Address City //��Q/ sta�tej � � yy� ZIP Code
STATE OF FLORIDA /,"'Q"'^- �'�
Sim of Notary Public
COUNTY OF -11Id 104 kol✓[-1'
Swom to (or affirmed) and subscribed before me this .3�
day of )4t(JUSti` ,20N .
Personally Known: V or Produced Identification:
Type of Identification Produced:
DS -DE 302NP (Rev. 11/17)
P nt. Type, or Stamp Cggiq2lqcioned Name of Notary Public below.
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OGG 21234 -
Rule 1S-2.0001, F.A.C.