Candidate Oath- BurchCANDIDATE OATH —
NONPARTISAN OFFICE
Do not use this form if a Judicial or School Board Candidate)
02-04-19 09 :5b _RC VD
Check box only if you are seeking to qualify as a
write -in candidate:
❑ Write -in candidate
OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a), Florida Statutes)
I, AEI G t �UjeG H
(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, must be printed above for oath purposes.)
�t,,the, (name
am a candidate for the nonpartisan office of VI LL��'f b E, C,0L ry (i j V
(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.
Candidate's Florida Voter Registration Number (located on your voter information card):
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.]
X i6k i, , ( 305) �l ? R57 �' ab c2 bae CA (@ tm
Signature of Candidate Telephone Number Email Address
i
�4q� Orel
Address City State ZIP Code
r
STATE OF FLORIDA
�'�m� j Print, Type, or Stamp Cd Name of Notary Public below:
�Or` �Q ��• •_��` Signature of Nota 7-,e
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
,V+4y No"=Ro } Florida
day of ►y �' .20la ,1� 0- y.;�
< 4q , Riy 244852 Personally Known: ✓ or Produced Identification: 3� =t,4' Exp
Type of Identification Produced
DS -DE 302NP (Rev. 11/17) Rule 1S- 2.0001, F.A.C.
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