Petition Drop Off Receipt MartinezMIAMFDMA�DE s'•
Miami -Dade Elections Department
2700 NW 87th Avenue
Miami, Florida 33172
305-499-8363
Petition Drop -Off Receipt
s� Nam ❑ Representative
has surrendered to the Elections Department
Petitions for �1 (� I/ pC�� '�l jUQ ?,
Quantity Candidate/initiative
Should the need arise to contact Candidate, please provide us with Candidate's:
Phone # Email Mailing Address
Petitions surrender d by:
c� '_A(a47"6'
Print/Sign epresentative) Municipality/Organization U Date
Petitions received by:
Print/Sign (El ctions Staff) Date