Loyalty Oath
LOYALTY OATH
OFFICE USE ONLY
(Sections 876.05-876.10, Florida Statutes)
CANDIDATE WITH NO PARTY AFFILIATION
STATE OF FLORIDA
COUNTY OF AI. /11 Br?fiC;l
I, IIOIL/ALO
First Name
~
We i L,ewv1J
Middle Nameflnitial
Last Name
a citizen of the State of Florida and of the United States of America, and being [a candidate for public office] do
hereby solemnly swear or; affirm that I will support the Constitution of the United States and of the State of Florida.
Important: If elected, a candidate must retake the loyalty oath as specified in s. 876.05, Florida Statutes, and that oath shall be
filed with the records of the governing official or employing govemmental agency prior to the approval of payment of salary,
expenses, or other compensation.
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
I, K Oy1../ AGO ;Fe - GAJe/t./!/UtJ
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT no NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
; I am a qualified elector of
tfi1I/Yoe
.
(office)
P4&/?1 ;gf</'fOT
(district)
County, Florida;
am a candidate with no party affiliation for the office of
(circuit) (group)
I am qualified under the Constitution and the Laws of Florida to hold the office to which I desire to be nominated or
elected; by executing this form, I have taken the oath required by ss. 876.05-876.10, Florida Statutes; I have
qualified for no other public office in the , the term of which office or any part thereof runs concurrent with the
office I seek; and I have resigned many ffice from which I am required to resign pursuant to Section 99.012,
Florida Sta~es. /'/
X~/,f? (,r~/)02/~ /077 fllJ~m;Wj~~W~
Signature of Candidate Telephone Number Email Address
c2~ YO ~ c"V-
Address
/5/~ s/ ~d3#lC~
City
/{
State
g 1 y26
ZIP Code
Sworn to (or affirmed) and subscribed before me this ~ day of
,2010 .
Personally Known: / or
Produced Identification:
Sig ature of Notary Public - State of Florida
Pr" t, Type, or Stamp Commissioned Name of Notary Public
02 :ZI Wd 92 Nvr OL
3:J1.:1.:10 S.}lH31:J ),113
H3V38 HOJ.NAOS .:l0 j,l!J
NOTARY PUBliC-STATE OF FLORIDA
~""""""" Janet M. Prainito
~~ }~ommission # DDs92173
",."".." f' .,~s: SEP. 05,2010
BONDED THhc, IC BOl'iDJ\G CO., INC.
Type of Identification Produced:
OS-DE 248 (Rev. 11/09)