HomeMy WebLinkAboutHerrold - Candidate Oath - 6-9-26CANDIDATE OATH
NONPARTISAN OFFICE
/ RECEIVED /
(Do not use this form if a Judicial or School Board Candidate)
JUN U 9 2026
Check box only if you are seeking to qualify as a write-in candidate:
❑ Write-in Candidate
JO' Ile/gym•
Name to appear on ballot: L\
eck box if there are two last names without hyphen. (Name cannot be changed after qualifying.)
W
eck box if name includes nickname. (To use nickname, you must complete the Affidavit of Nickname on page 2 of this form.)
swear or affirm that I am a candidate for the nonpartisan office of C pM 5�1� \ �51(� n o f " 5
(ice)
{�
I am a qualified elector of C" \ 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 1 will support the
Constitution of the United States and the Constitution of the State of Florida.
---A ar or affirm, in addition to being a citizen of the United States, that: (Check applicable box.)
T1 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.)
riding Fines, Fees, or Penalties: (Check applicable box. If you do owe more than $250, you must also specify the
Statement ofFanach
amount owed entity that levied the same on page 2 of this form.)
do not 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 sta ards of con ct and disclosure requirements, or chapter 106. (s. 99.021(1)(d), F.S.)
Si re Candi a Telephone Number Email Address
Address of Lega es2en a City State ZIP Code
STATE OF FLORIDA 1-2
j �/U�i2���
COUNTY OF D L(UC1 1 A"a
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 ❑ OR physical presence K •.,
•, DONNA L. BARTLE
MY 6519
this day of TK n (� 2O �U. "�
po..
ExPIRESSM y#4
'•FOF F�� ••
Type of Identification Produced: /V / 1q
DS-0E 302NP-E Corr. Eff. 04/20261 Emeraencv Rule 1SER26-2 F.A.C.
Page 1 of 2
col.6
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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).
Lj��) q V—�tC OU
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 �X1.9 s cAeCK I am over the age of eighteen (18) and the
contents of this affidavit are true and correct.
My nickname is Lt s Q �) I e– r r �l� I am generally known by this nickname or
have used it as part of my legal name. I have not created a nickname to mislead voters. My nickname does not imply 1 am some other
person, constitute a political slog or othe se ciat wit a use or issue, or that is obscene or profane.
Signature of Cand ate: Y
-j
STATE OF FLORIDA
COUNTY OF D 4V (L1
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 ❑ OR physical presence
this vl day of T(A. h e, 20 = `"= DONNA L. BARTLE
t1 MY COMMISSION # HH 643519
Type of Identification Produced: Aj/ r' '�EOFF��" EXPIRES: May 14, 2029
DS -DE 302NP-E Corr. Eff. 04/2026 Emerqencv Rule 1SER26-2 F.A.C.
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