Form Ds-De 24c - Precinct Committee Oath - Precinct Committeemen And Committeewomen
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1
2CANDIDATE OATH -
PRECINCT COMMITTEEMEN AND
COMMITTEEWOMEN
OFFICE USE ONLY
OATH OF CANDIDATE
(Section 99.021, Florida Statutes)
I,
(PLEASE PRINT NAME AS YOU WISH IT TO APPEAR ON THE BALLOT * -- NAME MAY NOT BE CHANGED AFTER THE END OF QUALIFYING)
am a candidate for the office of Precinct
Committeeman
Committeewoman
Precinct Number ____________,
I am a qualified elector of ____________________________ County, Florida; I am qualified under the Constitution and the
Laws of Florida to hold the office to which I desire to be nominated or elected; and I will support the Constitution of the United
States and the Constitution of the State of Florida.
Candidate’s Florida Voter Registration Number
: _______________________________
(located on your voter information card)
* Please print name phonetically on the line below as you wish it to be pronounced on the audio ballot for persons with
disabilities (see instructions on page 2 of this form):
__________________________________________________________________________________
STATEMENT OF PARTY
(Section 99.021, Florida Statutes)
I am a member of the _______________________________ Party; I have not been a registered member of any other political
party for 365 days before the beginning of qualifying preceding the general election for which I seek to qualify; and I have paid
the assessment levied against me, if any, as a candidate for said office by the executive committee of the political party, of
which I am a member.
(
)
X
Signature of Candidate
Telephone Number
Email Address
Address
City
State
ZIP Code
STATE OF FLORIDA
COUNTY OF ________________________
Sworn to (or affirmed) and subscribed before me this _______ day of __________________, 20_____.
Personally Known: __________ or
________________________________________________
Signature of Notary Public
Produced Identification: _____________
Print, Type, or Stamp Commissioned Name of Notary Public
Type of Identification Produced:
____________________________________________________
DS-DE 24C (Rev. 5/11)
Rule 1S-2.0001, F.A.C.
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