HomeMy WebLinkAboutNotice of Candidacy and Affidavit Richard J. Mohrig0<'IyE '�i
M11T(J\
To: The City of Milton Office of the City Clerk
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
my residence address is—
(Street
s(Street Number) (Street)
(City) (County)
my post office address is c)
(State)
RECEIVED Vi3'�
AUG 2 E 2013 V�
CTrY CLERK
CITY OF MILTON
(Zip Code)
e 61, / f(hon,r6 4 3coDi
my telephone number is- G 6,3,� 7 70
(Business) %/ (Home)
Y P P ( Y) i Ljt ( �I f a -T l ' n 0 bi? f/0 VL C#-
m profession, business, or occupation if an is
my email address is
eA L 0 (p x
the name of my precinct is h (%L(C J ; 1 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 office I am
seeking is ( 7-o C 1 D -S ; my date of birth is ����
(District/Pos
h f✓ f
I have been a legal resident of the State of Georgia for consecutive years; I have been a legal
J
resident of �' U ! tyk\ _ county for consecutive years; I have been a legal resident of
my district 1 for 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 L �� (� �- /� l ��� .5�� C 1 "Z �� t,,v
1 �— (Election)
to be held on the day of A10 V !�M ffk , 20 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. II, Sec. 1I, paragraph III), 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 I am seeking.
(Sign a of Candidate)
Sworn to and subscribed before me this ZY /' day of �0111��� C6 A " 0%14- , 20
...
(Notary ublic) Cn t'49 Z
�5 edo
CIc y
Q•
My Commission Expires
(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): I
Itln%Piq
(Please Print)
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Should I be elected, I desire that my name
appear on official documents as follows:
I- cif 0 ,- .T A(DIfr,
(Please Print)
CHECK ONLY ONE
1. ❑ I am running in a special election for a partisan office and my party affiliation is
&J/1'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):
2. ❑ I am required to file the above Notice followed by a nomination petition containing at least
valid signatures due
,20
E21'am not required to submit a nomination petition pursuant to O.C.G.A. § 21-2-132, because I am:
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.
3. LSI I hereby tender cash/check in the amount of S 3 LO, 0 6)
Name of Bank: (_ NA �E A AM -14 /v 8/q,')A
Check Number: -# Is 3 D
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).
❑ 1 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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