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AFFIDAVIT OF UNDUE BURDEN
(Section 99.097(4), Florida Statutes)
IMPORTANT: (1) Paying signature gatherers will preclude or invalidate the filing of an undue burden
oath. Section 99.097(6), Florida Statutes, provides: (a) If any person is paid to solicit signatures on a petition, an
undue burden oath may not subsequently be filed in lieu of paying the fee to have signatures verified for that
petition. (b) If an undue burden oath has been filed and payment is subsequently made to any person to solicit
signatures on a petition, the undue burden oath is no longer valid and a fee for all signatures previously submitted
to the supervisor of elections and any submitted thereafter shall be paid by the candidate, person, or organization
that submitted the undue burden oath. If contributions as defined in s. 106.011 are received, any monetary
contributions must first be used to reimburse the supervisor of elections for any signature verification fees that
were not paid because of the filing of the undue burden oath. [Note: The second sentence in (b) applies only
when payment is made to a signature gatherer after an undue burden oath had been filed.]
(2) Upon a candidate terminating the campaign, any candidate who qualified by the petition process and who
has surplus funds, must first apply the surplus funds to the reimbursement of the signature verification fee (if
applicable). See s. 106.141(7), Florida Statutes.
I certify under oath that I intend to qualify as a candidate for the office of
eiCrrYn i 5 ( Q' 1ST -AA eT 3 and that I am
unable to pay the fee for verification of petition signatures for that office
without imposing an undue burden on my personal resources or on
resources otherwise available to me.
M4A-Tio
Print Candidate's Name
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Address , City
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Telephone Number
State of Florida
County of OI2S ) (off
Sworn to (or affirmed) and subscribed before me this `t day of tJ 0 IQ € , 20 2
by AA -10-11 & rV(,ri--tG
Personally Known: or
Produced Identification: )(
Type of Identification Produced:
t, D(ZNe-,r-5 CLV5(>
Signature of Notary Public —State of Florida
Print, Type or Stamp Commissioned Name of
Notary Public
)I NISI 1101 DRZIDGI.
1'IR 1 I I,ruain u;. 2022
DS -DE 19A (Rev. 6/15)