Candidate’s Florida Voter Registration Number (located on your voter information card):
CANDIDATE OATH –
STATE AND LOCAL PARTISAN OFFICE
Check applicable one:
Candidate with party affiliation
Candidate with no party affiliation
Write-in candidate
X
( )
Signature of Candidate
Telephone Number Email Address
Address City State ZIP Code
STATE OF FLORIDA
COUNTY OF Signature of Notary Public
Print, Type, or Stamp Commissioned Name of Notary Public below:
Sworn to (or affirmed) and subscribed before me by
physical or
online presence this day of , 20 .
Personally Known: or Produced Identification:
Type of Identification Produced:
(Section 99.021(1)(a), Florida Statutes)
I,
(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 office of
,
,
,
(Office) (District #) (Circuit #)
; my legal residence is County, Florida; I am a qualified elector
(Group or Seat #)
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.
Statement of Party
(Section 99.021(1)(b), Florida Statutes)
(Complete Statement of Party only if you are seeking to qualify for nomination as a party candidate.)
I am a member of the
Party; I have not been a registered member of any other political
party for 365 days before the beginning of qualifying preceding the general election for which I seek to qualify; and I have paid
the assessment levied against me, if any, as a candidate for said office by the executive committee of the political party, of which
I am a member.
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.]
