HomeMy Public PortalAboutAffidavit of Financial HardshipFlorida Elections Commission
AFFIDAVIT OF FINANCIAL HARDSHIP
I Samuel Kent Chambers , a candidate for the office of
Pant Name
Orlando City Council District 3 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
$ _(Q 59 •
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.
--,
j X11,,
Date
Address:3333 Pelham Rd.
(in
Signature of Candidate
city:Orlando state: Florida zip:32803
Sworn to (or affirmed) and subscribed before me this
5Ar11Va aor Cf 6E-11-5
Signature of Notary Publi — State of Florida
Print, Type, or Stamp Commissioned Name of Notary Public
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Personally Known Produced Identificationi
Type of Identification Produced FL- Q U()&4'S (.(C Eat) )
Received by:
Name: Telephone:
City Date of Election: