Ford - Candidate Oath - 8-29-22 CANDIDATE OATH -
NONPARTISAN OFFICE }Ft f-tr,TTInD
(Do not use this form if a Judicial or School Board Candidate) AUG 2 9 2n'22
Check box only if you are seeking to qualify as a G ----
write-in candidate: BY:
❑ Write-in candidate OFFICE USE ONLY
Candidate Oath
(Section 99.021(1)(a),Florida Statutes)
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(Print name above as you wish it to appear on the ballot. If your last name consists of two or more names but has no
hyphen, check box ❑ (see page 2 - Compound Last Names). No change can be made after the end of qualifying.
Although a write-in candidate's name is not printed on the ballot, the name must be printed above for oath purposes.)
am a candidate for the nonpartisan office of aver , N/� ,
Office) _ (District#)
N pt ; I am a qualified elector of �a q 1 ' County, Florida;
(Cl cult#) (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.
Candidate's Florida Voter Registration Number(located on your voter information card): /03 841767q
Phonetic spelling for audio ballot: Print 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 2 of this form):(Not applicable to write-in candidates.]
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Signature of Candid a Telephone Number Email Address
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32233
Address City State ZIP Code
STATE OF FLORIDA
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Signature of Notary Public
COUNTY OF Pu 1 V h Print,Type,or Stamp Commissioned Name of Notary Public below:
Sworn to(or affirmed)and subscribed before me by mean'of
online notarization ❑ OR physical presence DONNA!_.BARTLE
" MY COMMISSION#HH 085656
this 2� day of I'rt�tA dG5 2� Z y,;--74 :•:
JJ •;,, .ate�P`� EXPIRES:May 14,2025
�,,/ d�Q�:' Bonded TAN Notary Public Underwriters
Personally Known LJ OR Produced Identification ❑ !.— ""
Type of Identification Produced: N/0
DS-DE 302NP(Rev.05/2021) Rule 1S-2.0001, F.A.C.