Bole - Candidate Oath - 8-27-24 CANDIDATE OATH
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate) ) RECEIVED
Check box only if you are seeking to qualify as a write-in
candidate: AUG 2 7 2024
1Write-in candidate
OFFICE USE ONLY
Candidate Oath
Name to appear on ballot: R tA.,( O I-- E
Check box if two last names without hyphen. ❑ (Name cannot be changed after qualifying.)
Check box if name includes nickname. ❑ (For use of a nickname,you must complete the Nickname Affidavit on reverse side.)
I swear or affirm that I am a candidate for the nonpartisan office of C col fr 7- A!C`2—, — 5 5 Ai T
P/
(Office) (District#
N/ , ; I am a qualified elector of -2(1t V 6 L County, Florida'
(Circuit#) (Group or Seat#)
I am a qualified elector 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.
Statement of Outstanding Fines, Fees, or Penalties
I owe outstanding fines,fees, or penalties, that cumulatively exceed$250,for ethics or campaign finance violations(s. 99.021(1)(d), F.S.).
YES, l Do NO, l Do Not 1‹
If you do,you must also specify the amount owed and each entity that levied the same on the reverse side.
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Signature of Candidate Telephone Number Email Address
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Address of Legal Residence City State ZIP Code
STATE OF FLORIDA
Ali I/i a 141/itle,
COUNTY OF D(/LVA, l Signature of Notary Public
Print,Type,or Stamp Commissioned Name of Notary Public below:
Sworn to(or affirmed)and subscribed before me by means
—h off
online notarization ❑ OR physical presence LY1
J+h r T^ . DONNA L.IiARTLE
this 2 f day of f-� Ka A s± ,20 L L . •
J I"'A•:.:' ,.• ' MY COMMISSION#HH 085656
�(' g EXPIRES:May 14,2025
Personally Known I"I OR Produced Identification
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�•......:.. Bonded rnN No4uy Public UnderwriUrs
Type of Identification Produced: '�—
DS-DE 302NP(Eff. 10/2023) Rule 1S-2.0001, F.A.C.
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Phonetic Spelling of Name
Phonetic spelling for the audio ballot(not required for qualifying purposes): Print the 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 3 of this form):
Statement of Outstanding Fines, Fees or Penalties
Pursuant to Section 99.021(1)(d), F.S., each candidate, whether a party candidate, a candidate with no party affiliation, or a write-in
candidate, shall,at the time of subscribing to the oath or affirmation,state in writing whether he or she owes any outstanding fines,fees,
or penalties that cumulatively exceed$250 for any violations of s.8,Art. II of the State Constitution,the Code of Ethics for Public Officers
and Employees under part Ill of chapter 112,any local ethics ordinance governing standards of conduct and disclosure requirements,or
chapter 106.
Amount Entity
O \P
Affidavit of Nickname (Only required if using nickname for the ballot.)
My legal name is . I am over the age of eighteen (18)and the contents of this
affidavit are true and correct.
My nickname is . I am generally known by this nickname or have used it as part
of my legal name. I have not created the nickname to mislead voters. My nickname does not imply I am some other person, constitute
a political slogan or otherwise associate me with a cause or issue, or that is obscene or profane.
Signature of Candidate:
STATE OF FLORIDA
COUNTY OF
Signature of Notary Public
Print,Type,or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed)and subscribed before me by means
of online notarization ❑ OR physical presence ❑
this day of ,20
Personally Known ❑ OR Produced Identification ❑
Type of Identification Produced:
DS-DE 302NP(Eff. 10/2023) Rule 1S-2.0001, F.A.C.