Petition Drop off receipt MarinbergMIAMI-=DADE N6� f'q a��)
Miami -Dade Elections Department
2700 NW 87b' Avenue
Miami, Florida 33172
305-499-8363
Petition Drop -Off Receipt
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BUG has surrendered to the Elections Department
Name- f Representative
Petitions for N ` C
Quantity
uanti Candidate/initiative
Should the need arise to contact Candidate, please provide us with Candidate's:
Phone #
Email
Mailing Address
Petitions surrendered by:
Print/Sig'ri (R resentative) Municipality/Organization ate
Petitions receivd by:
Print/Sign (EI ns Staff Date
DATE STAMP:
*Provide a completed copy to the Registration Manager*