Kelly- Candidate Oath- 6-22-17OS -DE 25 (Rev. Sit 1) Rule 1S-2.0001, F.A.C.
Received
CANDIDATE OATH —
juN 2 2 2011
NONPARTISAN OFFICE
Office of City Clerk
(Not for use by Judicial or
School Board Candidates)
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021, Flonda Statutes)
(PLEASE PRINTNAME AB YOU WISH IT APPEAR O��NllllTHE BALLOT MAY AMR ME END OF QUALIFYING)
�'�-�NAME ,NOT
, �B,ECHANGED
am a candidate for the nonpartisan office of ITfIfi�K, �5(X1C11 �Ar7 LAN I lml�$ I o"' -,L
(office) (di#idel#)
_��..I am a qualified elector of D(,(y County, Florida;
(circuit#) (group or mud #)
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 Stales and the Constitution of the
State of Florida.
x (�czeQ� ( 7 2(47. 550 c 41 Iy NZ)
Signature of CandidW Telephone Number Email Addrdird
IyA Rilm;�cm S�• PL :pa3
Address City State Code
iJZIP
Candidate's Florida Vater Registration Number information I03 IL4 O
(located on your voter card):
' Please print name phonetically on the line below as you wish A to be pronounced on the audio ballot for persons
with disabilities (see instructions on page 2 of this form):
VAN- 8,ace,M—
STATE OF FLORIDA
COUNTY OF DVI Vh I
Sworn before this o1ei� day j-1krf2 20 /7.
to (or affirmed) and subscribed me of
DONNAL. SARTLE ��
Personally Knovm: orFjP.frYt
1 MYCOMMISSIGN#GG 018827
i• ignatum of Notary Publie
EXPIRES. May 14, 2021
Produced Identification: •.;T,G'sokM lAm NWryPoOa Unaswmer rint Type, or Stamp Commissioned Name of Notary Public
Type W Identification Produced:
OS -DE 25 (Rev. Sit 1) Rule 1S-2.0001, F.A.C.