HomeMy Public PortalAboutAffidavit of Financial HardshipFlorida Elections Commission
AFFIDAVIT OF FINANCIAL HARDSHIP
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Print Name
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, 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
$ (O JE • �— 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
Signata'L'af"Can
Address: /Le W € Sir yA
City: DALPY1000 State: k ZipV )g'()
Sworn to (or affirmed) and subscribed before me this day of —14-) 20 oL 1 by
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Signature of Notary Public — State of Florida
Print, Type, or Stamp Commissioned Name of Notary Public
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Personally Known Produced Identification X
Type of Identification Produced
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Received by:
Name: Telephone:
City Date of Election: