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Home My WebLink AboutStaats - Candidate Oath - 6-8-26`'2026 Qualifying Checklist for Filing Officer's Use CANDIDATE NAME: IUar1e lukAx Ada S DATE: OFFICE• 3 ayor-Commissioner —Seat 1 ❑ Commissioner — Seat 4 ❑ Commissioner — Seat 5 INCUMBENT? ❑ YES V O VAppointment of Campaign Treasurer (Form DS -DE 9) Filed for each treasurer/deputy treasurer Treasurer: Deputy Treasurer(s): Bank: Dee Refer 6115 7 4ekic It Cg Statement of Candidate (Form DS -DE 84 (Eff. 4/2026)) Filed Lid' Nomination Petition process met Eectidate Oath — Nonpartisan Office version of form submitted (DS -DE 302NP-E Corr. (Eff. 04/2026)) Under oath, name as it is to appear on the ballot Check box if you have a compound name without a hyphen (Last Name affects placement on ballot) Check box if you have a nickname AND complete affidavit on back of oath, notarized Q/"Office" provided (Example: Mayor -Commissioner - Seat 1, Commissioner -Seat 4, etc.) "District" should be N/A V"Circuit #" should be N/A `Group or Seat #" (1, 4, or 5 whichever relates to the office you are seeking) Vchecount of legal residence provided Duval k Y g P ( ) applicable box swearing that "I am not" OR "I am" a citizen of another country AND if also a citizen in another country, specify which country. Acknowledgement of Outstanding Fines, Fees, or Penalties, A�'s, complete detailed statement n page 2. Candidate original signature provided (If you are acting as Notary, have them take an oath and then have them sign) Phone number, email address, and address of legal residence provided 0/�hlysical nue (county where oath taken) resence or Online resence indicated p P ate of notarization provided Ve known or Produced identification is indicated h ntification type provided, if needed; otherwise use "N/A" tains notary signature 2:0tary stamp (with notary's name) afxed below signature�otary commission not expired when notarized 5 Phonetic Spelling of Name (not required forqualifying) f� pecify the amount owed for each entity if A Do" was checked /V/A Affidavit of Nickname (Only required if using nickname for the ballot) must be notarized NAh 2026 Qualifying Checklist Page 1 of 2 Name &Any VAVc , MIP Financial Disclosure (Form 1) ❑ 2025 Form 1 submitted via electronic filing system: ❑ Receipt (incumbent) OR lD'Fo /Candidate's (digital) signature provided r[t� orm is complete, including n/a when there is nothing to report on part of the form Q Form is complete, including attachments -P✓eNF Electiog�issessment Fee (Mayor $139.62 OR Commissioner $112.43) Payable to the City of Atlantic Beach eck drawn on campaign account (Official, bank, cashier's check not acceptable) C k drawn on bank gdesignated on DS -DE 9 ount paid 3 / . 62- ount is not less than the qualifying fee (check written amount) Lit Written and numerical numbers are both filled in and are the same P'Check signed by ❑ treasurer, OR N �-►� G S'�GA.�S deputy treasurer, /Processed payment through AB Cashier, obtained validated receipt to file as proof of payment SOE�Do;uments (not required to qualify) lla' L & A Receipt signed NOTE: F.S. 99.061 WC) The filing officer performs a ministerial function in reviewing qualifying papers. In determining whether a candidate is qualified, the filing officer shall review the qualifying papers to determine whether all items required by paragraph (a) have been properly fled and whether each item is complete on its face, including whether items that must be verified have been properly verified pursuant to s.92.525(1)(a). The filing officer may not determine whether the contents of the qualifying papers are accurate. ❑ Redact address & phone number from check and documents, if protected ❑ Redact social security numbers and PINS on tax returns, if applicable ❑ Redact routing numbers on check ❑ Scan documents ❑ Add documents to LF ❑ Send Oaths to DCSOE, Cierra Fackler at CFackler@coj.net ❑ Show as qualified on website 2026 Qualifying Checklist Page 2 of 2 CANDIDATE OATH NONPARTISAN OFFICE / RECEIVED (Do not use this form if a Judicial or School Board Candidate) JUN 'i 8 1016 Check box only if you are seeking to qualify as a write-in candidate: l;oga.m- Agt� ❑ Write-in Candidate OFFICE USE ONLY Name to appear on ballot: % S Ct.l i �Jjob ❑ Check box if there are two last names without hyphen. (Name cannot be changed after qualifying.) ❑ Check box if name includes nickname. (To use nickname, you must complete the Affidavit of Nickname on page 2 of this form.) I swear or affirm that I am a candidate for the nonpartisan office of Ma ljo �- ('arnrn t ss I (Office) I; I am a qualified elector of u VA- County, Florida; (District #) (CrYcuit #) (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. I swear or affirm, in addition to being a citizen of the United States, that: (Check applicable box.) I am not a citizen of another country. ❑ 1 am a citizen of another country, specifically Statement of Legal Name Change: I have not legally changed my name through a petition pursuant to s. 68.07, F.S., during the 365 - day period preceding the beginning of qualifying. (This does not apply to any change of name in proceedings for dissolution of marriage or adoption of children or based on a change of name conducted with a marriage certificate.) Statement of Outstanding Fines, Fees, or Penalties: (Check applicable box. If you do owe more than $250, you must also specify the amount owed and each entit that levied the same on page 2 of this form.) I do not ® / 1 do owe 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 III of chapter 112, any local ethics ordinance governing standards of conduct and disclosure requirements, or chapter 106. (s. 99.021(1)(d), F.S.) /x !/G (7-32,-) � 8l 6 /'V 9 StGza;9n 7rSignat7ure fCandi toTelephone Number Email Address Alan%� 32233 20,3'6 aC;% 74X_ f3eA�J�t Address of Legal Residence City State ZIP Code STATE OF FLORIDA COUNTY OF J ltya I Signature of Officer Administering Oath Sworn to (or affirmed) and subscribed before me by means of Affix Seal Below or, if judge, provide name, title, and court (s. 92.50, F. S.) online notarization ElORphysical presence Er ::>`��! _ DONNA L. MRTLE this C7T day of JL(,il Pi ZO-g-., '_" MY COMMISSION # HH 643519 EXPIRES: May 14, 2029 '•,SUP F�,. Type of Identification Produced: AJI,9 DS -DE 302NP-E Corr. Eff. 04/2026 Emerciency Rule 1SER26-2 F.A.C. Page 1 of 2 Page 2 of 2 Phonetic Spelling of Name (Not required for qualifying) Print the name phonetically on the line below as you wish your name to be pronounced on the audio ballot that may be used by persons with disabilities (see attached Guide for Phonetic Spelling). STAHTS , P Detailed Statement of Outstanding Fines, Fees, or Penalties (Continued) Amount Entity 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 Officer Administering Oath Affix Seal Below or, if judge, provide name, title, and court (s. 92.50, FS.)Sworn to (or affirmed) and subscribed before me by means of online notarization 1:1 OR physical presence ❑ this day of 20 Type of Identification Produced: DS -DE 302NP-E Corr. Eff. 0412026 Emerciencv Rule 1SER26-2 F.A.C. Page 2 of 2