HomeMy WebLinkAboutNotice of Candidacy and Affidavit Karen Lea Collins ThurmanLTON RECEIVED
AUG 2 6 2013 Am
Crit' CLERK
To: The City of Milton Office of the City Clerk QTY OF MILTON
13000 Deerfield Parkway
Suite 107A/B
Milton, GA 30004
NOTICE OF CANDIDACY AND AFFIDAVIT
CITY OF MILTON
I, the undersigned, being first duly sworn on oath, do depose and say: my name is
�' ex kA �-P n., C -b `k t rC' 1 k ( , r r
my residence address is J l I a )(9- __ 2) Qn _ C'k
(Street Number) (Street)
(City) (County) (State) (Zip Code)
my post office address is
my telephone number is '--kck . 15 7, 7J g0 -1-70.
(Business) (Home)
my profession, business, or occupation (if any) is L l r eCX l.t 61 I C (- c G LA n ra'4
my email address is - k)� CMOLO L o0 Q6-S0LL% , ne-�
the name of my precinct is ` `Ltd _; I am an elector of the municipality of my residence eligible to
vote in the election in which I am a candidate; that the name of the offic^e-loam ^
seeking is %SV C.V \ m PeC4 1 ; my date of birth is J1.�1 tt C.,)
(District/Post)
I have been a legal resident of the State of Georgia for 5 �) consecutive years; I have been a legal
resident of FLA\ U n county for a 00 consecutive years; I have been a legal resident of
my district , for i consecutive years; I am a citizen of the United States; I am eligible
to hold such office; that I am a candidate for such office in the G ex -\e- ra `
(Election)
to be held on the day of (� '14ober, zo) I have never been convicted and sentenced in
any court of competent jurisdiction for fraudulent violation of primary or election laws, malfeasance in office, or
felony involving moral turpitude or conviction of domestic violence under the laws of this State, any other State, or
the United States, or, if so convicted that my civil rights have been restored; and at least ten years have elapsed from
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the date of completion of the sentence without subsequent conviction of another felony involving moral turpitude;
and that I am not a defaulter for any federal, state, county, municipal, or school system taxes required of such
officeholder or candidate if such person has been finally adjudicated by a court of competent jurisdiction to owe
those taxes, but such ineligibility may be removed at any time by full payment thereof, or by making payments to
the tax authority pursuant to a payment plan, or under such other conditions as the General Assembly may provide
by general law (pursuant to Ga. Const. Art. ll, Sec. Il, paragraph 111), and that I will not knowingly violate any
provisions of the Georgia Election Code (O.C.G.A. §. 21-2) or of the rules or regulations adopted thereunder.
I understand that any false statement knowingly made by me in this Notice of Candidacy and Affidavit will subject
me to criminal penalties as provided by law and I hereby request you to cause my name to be placed on the ballots to
be used in such election as a candidate for the office 1 am seeking.
Sworn to and
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`�%%% g A M
`�� • f GpMM13;
IC
(Notary Pub'Mu)'v�N GIE�O�``
My Commission Expires j. z&. /`i'
J � am-� C ` % w,,, ,-
(Signature of Candidate)
day of Au 6gS-T —,20)3.
RECEIVED
(Required by Ga. Election Code O.C.G.A.§ 21.2.132.)
I desire that my name appear on the ballot as
Follows (the surname of the candidate shall
Be as it appears on the candidate's voter
Registration card):
Ii ar' ,A C. 7'n t -\r ar,
(Please Print)
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AUG 2 6 2013
MY CLERK
CITY Or M&TON
Should I be elected, I desire that my name
appear on official documents as follows:
(Please Print)
CHECK ONLY ONE
1. ❑ I am running in a special election for a partisan office and my party affiliation is
E211 I am running as a nonpartisan candidate.
❑ I am running as an independent candidate.
❑ I am the nominee of the
Party (Body) nominated by:
❑ Convention (Certified copy of the minutes of the convention attested by the Chairman
and Secretary of the convention is being filed herewith);
❑ Other (Specify method of nomination and statute and party rule governing and allowing
such method of nomination):
❑ I am required to file the above Notice followed by a nomination petition containing at least
valid signatures due
,20
I am not required to submit a nomination petition pursuant to O.C.G.A. § 21-2-132, because 1 am:
Eo"Running as a nonpartisan
❑ Running as an incumbent.
❑ Running in a special election.
❑ Running for a state-wide office nominated by a duly constituted political body
convention.
L� I hereby tender cash/check in the amount of S
Name of Bank: EJ041N IL 0` �rne_61Q_cl
Check Number: Z)3 is
In the event that a candidate pays his or her qualifying fee with a check that is subsequently returned for insufficient
funds, the Superintendent shall automatically find that such candidate has not met the qualifications for holding the
office being sought, unless the bank, credit union, or other financial institution returning the check certifies in
writing by an officer's or director's oath that the bank, credit union, or financial institution erred in returning the
check as prescribed in O.C.G.A. § 21-2-6 (d).
❑ I hereby file a Pauper's Affidavit, accomplished by a qualifying petition as prescribed in O.C.G.A. § 21-2-
132 (g), in lieu of paying the qualifying fee.
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