Loyalty Oath
LOYALTY OATH
'I1Y M~!ACH
CITY CLERK'S OFFICE
10 JAN 21 AM 7: 31
(Sections 876.05-876.10, Florida Statutes)
NON-PARTISAN OFFICE
STATE OF FLORIDA _ t
COUNTY OF 'Fa {W\ ~C<..~
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Or (OVe-
First Name
Middle Name/Initial
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 governmental agency prior to the approval of payment of salary,
expenses, or other compensation.
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
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(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT
Or\ove..-
NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the non-partisan office of ~ vctoIA
; I am a qualified elector of
~e-t<..~ C ('ty COW\l''1~.~SS(oV\, 1-
(office) ~J (district)
pt(. t VV\ 13~ctL ~ County, Florida;
(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 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 St es
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ure of Candidate Telephone Number
L() 2sCe:i L.JCt..v\.b.rock vh'Je} T30)~o~ ~dtJ FL- S3L{5,b
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Sworn to (or affirmed) and subscribed before me this ~7 day of
Produced Identification:
e of Notary Public - State of Florida
pe, or Stamp Commissioned Name of Notary Public
Type of Identification Produced:
NOTARY PUBUC.STATE OF ~~DA
,.',....."" Janet M. Pramlto
{W 1 Commission #DD592173
..,,'f!!,... Expires: SLP. 0?,.2010
BONDED THRC ArLAXnC BONDlNI.J CO., INC.
OS-DE 25 (Rev. 11/09)