HomeMy WebLinkAbout2018 Opt - Affidavit of Undue Burden for 3 Rev 2018 08 09CITY OF WINTER SPRINGS, FLORIDA
2018 GENERAL MUNICIPAL ELECTION
AFFIDAVIT OF UNDUE BURDEN
I,
of Winter Springs governing body as
during General Election to be held on November 6, 2018, and that I hereby certify to the City of
Winter Springs that I am unable to pay the election assessment and qualifying fee for the office to which I seek
because said assessment and fee impose an undue burden on personal resources or on resources otherwwise
available to me pursuant to Section 99.032(2), Florida Statutes. I hereby agree to provide appropriate written
documentation to the City of Winter Springs to verify and support the certification provided by me in this Affidavit
if requested by the City of Winter Springs.
Signature
Street Address City
State Zip Code
STATE OF FLORIDA
COUNTY OF
Sworn to (or affirmed) and subscribed before me this
by
(Print Name of Person Making Statement)
Type of Identification Produced:
Revised 8/9/2018
Name of Candidate (Please Print or Type)
CITY COMMISSION: DISTRICT THREE
(Print/Type or Stamp Commissioned Name of Notary Public)
City Commission: District Three
Circle As It Applies To Candidacy
Circle As It Applies To Candidacy
Personally Known:
do hereby swear or affirm that I seek election to the City
day of
Signature of Notary Public - State of Florida
Date
OR Produced Identification:
, 2018