HomeMy WebLinkAboutCarol Mendelson- Candidate OathCANDIDATE OATH
NONPARTISAN OFFICE
(Do not use this form if a Judicial or School Board Candidate)
Check box only if you are seeking to qualify as a
write-in candidate:
❑ 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 mjdm—/IL�i( I L
(Office) (District #)
I am a qualified elector of CCounty, 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.
Candidate's Florida Voter Registration Number (located on your voter information card): %11 / Vgo 1 % U
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 Candidate Telephone Number Email Address
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Address City State ZIP Code
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STATE OF FLORIDA
Signature of Not ry Public
COUNTY OF & tjta r-J Print, Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by meansof
online notarization ❑ OR physical presence ✓tJ
;�*Y:'o4•KIMBERLY DILLON
..
1. r !/•�; Notary Public • State of Florida
this 13 day of jU11d, t„
p` Commission M GG 949181
a i `,,. My Comm. Expires Feb 3, 2024
Personally Known ❑ OR Identification Bonded through National Notary Asir,
\\Produced
Type of Identification Produced: •1 t cj pf ZiljL_
DS-DE 302NP (Rev. 08/2021) Rule 1S-2.0001, F.A.C.