HomeMy Public PortalAboutNOC.pdfTO: Janet LeViner, MMC, Qualifying Officer
City of Tybee Island, Chatham County, State of Georgia
NOTICE OF CANDIDACY AND AFFIDAVIT
CHATHAM COUNTY, CITY OF TYBEE ISLAND
I, the undersigned, being first duly sworn on oath, do depose and say: my name is_________________
___________________________________________________________________________________;
my residence address is ________________________________________________________________
(Street Number) (Street)
____________________________________________________________________________________;
(City) (County) (State) (Zip Code)
my post office address is_____________________; my telephone number ________________________
(Cell)
my profession, business, or occupation (if any ) is____________________________________________;
I am an elector of the county/municipality of my residence eligible to vote in the election in which I am a
candidate; the name of the office I am seeking is ____________________________________________;
my date of birth is______________________; I have been a legal resident of the State of Georgia for
_________ consecutive years; I have been a legal resident of Tybee Island for __________ consecutive
years; I am a citizen of the United States; I am eligible to hold such office; that I am a candidate for such
office in the Municipal Election to be held on the 2nd day of November, 2021;
I have never been convicted and sentenced in any court of competent jurisdiction for fraudulent violation
of primary or election laws, malfeasance in office, or felony involving moral turpitude or conviction of
domestic violence under the laws of this State, any other State, or of the United States, or, if so convicted
that my civil rights have been restored; and at least ten years have elapsed from the date of completion
of the sentence without subsequent conviction of another felony involving moral turpitude; I am not a
defaulter for any federal, state, county, municipal, or school system taxes required of such officeholder
or candidate if such person has been finally adjudicated by a court of competent jurisdiction to owe those
taxes, but such ineligibility may be removed at any time by full payment thereof, or by making payments
to the tax authority pursuant to a payment plan, or under such other conditions as the General Assembly
may provide by general law (pursuant to Ga. Const. Art. II, Sec . II, paragraph III); I will not knowingly violate
any provisions of the Georgia Election Code (O.C.G.A. § 21‐2) or of the rules or regulations adopted
thereunder.
I understand that any false statement knowingly made by me in this Notice of Candidacy and Affidavit will
subject me to criminal penalties as provided by law and I hereby request you to cause my name to be
placed on the ballots to be used in such election as a candidate for the office I am seeking.
_______________________________________________
(Signature of Candidate)
Sworn to and subscribed before me this _____ day of __________________, 2019.
_____________________________________________
(Notary Public)
My Commission Expires__________________________
(Required by Ga. Election Code O.C.G.A. § 21.2.132.)
I desire that my name appear on the ballot as follows (the surname of the candidate shall be as it appears on the
candidate’s voter registration card):
___________________________________
Please print
Should I be elected, I desire my name appear on official documents as follows:
___________________________________
Please print
I hereby tender check/money order in the amount of $_______________________________. NAME OF
BANK:______________________________ CHECK NUMBER:_____________ In the event that a candidate pays his
or her qualifying fee with a check that is subsequently returned for insufficient funds, the superintendent shall
automatically find that such candidate has not met the qualifications for holding the office being sought, unless the
bank, credit union, or other financial institution returning the check certifies in writing by an officer's or director's
oath that the bank, credit union, or financial institution erred in returning the check as prescribed in O.C.G.A. § 21‐
2‐6(d).
[ ] I hereby file a Pauper’s Affidavit, accompanied by a qualifying petition as prescribed in O.C.G.A. § 21‐2‐132(g),
in lieu of paying the qualifying fee.