Candidate Oath George BurchCANDIDATE OATH
NONPARTISAN OFFICE
02-07-23A 10:07 RC VD
(Do not use this form if a Judicial or School Board Candidate)
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, George E. Burch ,
(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 ofMiami Shores Village Council
(Office) (District #)
I am a qualified elector of M la m I -Dade 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): 109082975
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 (305) 343-2738 georgeburchdvm@gmail.com
Signature of Candidate Telephone Number Email Address
1440 NE 101st Street Miami Shores Florida 33138
Address City State ZIP Code
STATE OF FLORIDA �`� 4 '
ure of Notary Public
COUNTY OF 1*4( �� Print, Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by means of
online notarization ❑ OR tYr`
physical presenceRANDALLHILLIARD
Notary Public-! tate of Florfda
this uay of S 2�
Commission x HH 079707
My Comm. Expires Feb t3, 2025
Personally Known OR Produced Identification ❑ Bonded through National Notary Assn.
Type of Identification Produced:
DS-DE 302NP (Rev. 0812021) Rule 1S-2.0001, F.A.C.