HomeMy Public PortalAboutAffidavit of Financial HardshipFlorida Elections Commission
AFFIDAVIT OF FINANCIAL HARDSHIP
1, )�1C�il1�„c,
Print Name
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S4-010- (oP-wy) s) (.)'\
, a candidate for the office of
do hereby certify, pursuant to
Section 99.093(2), Florida Statutes, that I am unable to pay the 1% election assessment of
to qualify for nomination or election to public office because paying the assessment
would be an undue burden on my personal financial resources or on the financial resources available to
me. Under penalty of perjury, I declare that I have read the foregoing and that it is a true and correct
statement.
Date
Address: g ,C
City: C(1. CvLW
J2,
Signature of Can(lidate
W 1 A I)/ Ct�?�
State: Zip: .3 C
Sworn to or affirmed) and subscribed before me this 6 day of a;1 , 20 ? \ by
ev\k,iU()N
Signature of Notary Pu --Stet of Florida
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Print, Type, t oexni • ionet(4ame of Notary Public
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Received by:
Personally Known ✓ Produced identification
hype of identification Produced
Name:
Telephone:
City Date of Election: