Loyalty Oath-Oath of CandidateLOYALTY OATH
CANDIDATES WITH NO PARTY AFFILIATION
(Sections 876.05-876.10, Florida Statutes)
OFFICE USE ONLY
STATE OF FLORIDA
Miami-Dade COUNTY
(PLEASE PRINT)
First Name Middle Name/Initial Last Name
a citizen of the State of Florida and of the United States of America,... and 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.
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the office of ~-- i '~ ~f C O V~ i,,V~ i 5 "~ i C~ ~ ' N/A , NtA ,
J ~'"1 ~Ci,'~ ---(O. ffice)~ (district) (circuit)
~.~ ~,--~ County, Florida
I am a qualified elector of .
(group) 'in
I am a qualified elector of the City of Miami Beach Florida, residing within<?,e, City at least,one year before auahfy g
for City of Miami Beach elected office, with my iegal residence being:_~c5 r~q~--~ ~.f~ ~ ~ ~ .'~ ,
Miami Beach, Florida. I am qualified under the ordinances and Charter of said City an~ under the Cons{itution 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 reauired to resicln pursuant to Section 99.012, Florida Statutes.
SIGN H
UNDER PENALTIEs OF PERJURY, I DECLARE THAT I HAvE READ THE FoREGoING LOYALTY OATH AND OATH OF
CANDIDATE AND THAT THE FACTS STATED IN EACH ARE TRUE.
~ SWORN TO AND SUBSCRIBED before m th'e [nts
of,_ ..,~¢__4-~005, Notary Name: r~~ ~l~.~ day
Notary Public, State o.( F,~orida
Commission Expi/res: ~)D_C¢:~',;"2, F 7,, Personally Known: ~
Produced ID:' IZ Type: ~L,-~
Signature of Candidate