Candidate Oath CantorCANDIDATE OATH
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate)
0 2 -2 2-2 3P 0 2 : 36 R C V D Irp
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)
(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 Cou n e i I Mere be r
(Office) (District #)
I am a qualified elector of �� I aM _ j>,0 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):. { 0133ZI 2.4
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 (12-7) fey57 r "Ve qPa(0VCG,
Signitur4 of Cjqdie Telephone Number Email Address
E 101 54, Sko-res 33 %S8
Address City State ZIP Code
STATE OF FLORIDA
/1 Signature o Nota u lic
COUNTY OF I�IGIYYII Print, Type, or S ry Public below:
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR physical presence 1�i'
Cenxn.: III HH 306860
Nmber 30, 3036
(X,Zthis 9D' day of 2�.
Expires;ove
Personally Known ❑ OR Produced IdentificationNotary Ptlbiic- State of Florida
Type of Identification Produced: �IC e
DS-DE 302NP (Rev. 08/2021) Rule 1S-2.0001, F.A.C.