Petition in Lieu of Qualifying Fee Form
PETITION IN LIEU OF QUALIFYING FEE
MUNICIPAL ELECTION:
November 6, 2007
I, ___________________________________________ candidate for ______________________________________ of the City of Miami Beach, ask you to help me
qualify for the November 6, 2007 election by signing and providing the information below.
Yo, _________________________________________ candidate para ______________________________________ de la ciudad de Miami Beach, exhorto su ayuda
para calificar en las elecciones del 6 de noviembre del 2007 firmando y proveyendo la siguiente información:
Print Name Official Signature Within Box Residence Date of Birth or Registration Number
Nombre con letra de molde Firma official dentro de la caja Domicilio Fecha de Nacimiento
ó Número de Registración
1)
Date/Fecha:
2)
Date/Fecha:
3)
Date/Fecha:
4)
Date/Fecha:
5)
Date/Fecha:
FS 104.185 (1):
A person who knowingly signs a petition or petitions for a candidate or an issue more than one time commits a misdemeanor of the first degree,
punishable as provided in Section 775.082 or Section 775.083.
FS 104.185 (2):
A person who signs another person’s name or a fictitious name to any petition to secure ballot position for a candidate or an issue commits a
misdemeanor of the first degree, punishable as provided in Section 775.082 or Section 775.083.
(Additional signatures on Reserve)/Firmas Adicionales al Dorso
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Petition in Lieu of Qualifying Fee
Page 2
Print Name Official Signature Within Box Residence Date of Birth or Registration Number
Nombre con letra de molde Firma official dentro de la caja Domicilio Fecha de Nacimiento
ó Número de Registración
6)
Date/Fecha:
7)
Date/Fecha:
8)
Date/Fecha:
9)
Date/Fecha:
10)
Date/Fecha:
Statement of Circulator
Declaración del Distribuidor
The undersigned is the circulator of the foregoing paper containing ___________________ signatures. Each signature appended thereto was made in my presence
and is the signature of the person whose name it purports to be.
El que subscribe es el distribuidor de este papel, que contiene _______________ firmas. Cada firma se hizo en mi presencia, y es la firma de la persona a la
que corresponde.
Signature of Circulator: ________________________________ Address: __________________________________________________________________
Firma del Contribuidor: ________________________________ Dirección: _________________________________________________________________
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F:\CLER\HATL\Elections\2007\Petition in Lieu of Qualifying Fee.doc