Mark- Candidate Oath 6-15-15 Received
CANDIDATE OATH . JUN 1 5 2015
NONPARTISAN OFFICE
Office of City Clerk
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
•
OATH OF CANDIDATE
(Section 99.021,Florida Statutes)
I, )r c - . Inca' (
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT*-- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the nonpartisan office of CUrn m e 5'1 oil er Seal- 2. / 309
(office) (district#)
; I am a qualified elector of (71.t V Z' 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.
X ( ,c 4- k1 (ga(i) 0 3 58 y reed cheat Gi r/Lc
Signature of Candidate Telephone Number Email Address 9 yyv J.
i ! Y 8 kinks 3123
Address City State ZIP Code
Candidate's Florida Voter Registration Number(located on your voter information card): 1 0 3 3 11.a.
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons
with disabilities (see instructions on page 2 of this form):
n2/=1 /1) - 2Er -41-1 /Yt/ 1-1A K
STATE OF FLORIDA
COUNTY OF Ui,V61-I
Sworn to (or affirmed)and subscribed before me this 1 54 day of .kii e- , 20 13 .
j7� � 6-4vVe
Personally Known: or ���vY�it�
Signature of Notary Public
Produced Identification: Print,Type,or Stamp Commissioned Name of Notary Public
Type of Identification Produced: Y'4,4 DONNA L.BARTLE
A . MY COMMISSION#FF 018392
° Q EXPIRFS•May is 91117
Bonded Thru Notary Pubic Underwriters
DS-DE 25(Rev.5/11) 01,F.A.C.