HomeMy WebLinkAboutDSDE302NPCANDIDATE OATH —
NONPARTISAN OFFICE REGENED
(Do not use this form if a Judicial or School Board Candidate) pmc 3 � 2t19
Check write-in band date. ox only if you are seeking to qualify as a City of Se as't n
Cay Clerk
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Write-in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021 ( , Florida Statutes)
(Print name above as you ish it to eppdar in 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 bbe�p� printed above for oath purposes.)
am a candidate for the nonpartisan office of S RS4l G')') ` � � Ckill Lj '
(Office) (District #)
I am a qualified elector of L—A 0/ ( (k4l X/ 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):/ 0 qf0,-7 S yA—
Phonetic spelling for audio ballot: Print name phonedpally on the line below a ou wish it to be pronounced on the audio
ballot ay be used by persons with disabilities (see.ir( tructions on page 2 of th' f rmj: (Not applicable to write-in candidates.]
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Sinatura of Gandudate Telephone Number
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Address city
STATE OF FLORIDA
COUNTYOF.Thdi&_A 2iVe.r
Swom to (or affirmed) and subscribed before me this ,30-h
day of AuGt us f 2011?.
Personally Known. V or Produced Iderfificatio:r.
Type of Identification Produced:
Email P d cess
State �' .. ZIP Code
i ture of Nota Public
Pri , Type, wom"It�red Name of Notary Public below.
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DS -DE 302NP (Rev. M17) I,41111-111o",Rule 1 S-2.0001. F.A.C.