HomeMy WebLinkAboutNotice of Candidacy and Affidavit: Burt HewittTO: _0
' Superintendent of Elections
of County/Municipality
State of Georgia
NOTICE OF CANDIDACY AND AFFIDAVIT
(COUNTY/MUNICIPALITY)
I, the undersigned, being first duly sworn on oath, do depose and say: that my name is
that my residence address is
(Street Number)
113e+)un1 +�
(Street)
G�-
RECEIVED
CITY CLERK "'
QTY OF MILTON
(County) (State) (Zip Code)
that my post office address is.
that my telephone number is 770" 4k3- 5-Yoy
(Business) (Home)
that my profession, business, or occupation (if any ) is^^ �9�-C ;
that the name of my precinct is ue. it Mi J)� SLt+.a• 1 that I am an elector of the county/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
C t h CLVAC11-17iadrz10 4 ; that my date of birth is 03 %5 —;that I have been a legal resident
(Furnish Ci cuit, District, or Post if Applicab e)
,,.he State of Georgia for 3 Z years; that I have been a legal resident of 4hL1y,4 county for ��ears;
that I have been a legal resident of my district (if applicable) for years; that I have been a legal resident of my
circuit (if applicable) for years; that I am a_ci`tizen of the United States; that I am eligible to hold such office; that I am a
candidate for such office in the ��� , aj F4Gy 0— to be held on the a day of 4*4&- , 200;
(Election)
that 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 of the United States, or, if so convicted that my civil rights have been restored; and at least ten years have elapsed from 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. II, paragraph III), and that I will not knowingly violate any provisions of
the Georgia Election Code (O.C.G.A. Ch. 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.
Ak-
(Signature of Candidate)
�11Ii1W' 1�
/
Sworn to and subscribed before me this 29
day of , 20
(Notary Public)
My Commission Expires f�
(Required by Ga. Election Code, Sec. 21-2-132.)
Form-NC-C&M-05 (over)
r
1. I desire that my name appear on the ballot as follows:
L� V RT 4 a.wT-Tr
(Please Print)
2. (a) I am running in a special election for a partisan office and my party affiliation is
(b) I am running as a nonpartisan candidate [ K1.
(c) I am running as an independent candidate [ ].
(d) 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 an statute and party rule governing and allowing such method of nomination):
3. (a) [ ] I am required to file the above Notice followed by a nomination petition containing at least
valid signatures due
(b) [ ] I am not required to submit a nomination petition, because I am:
[ ] Specify [Code § 21-2-132]:
4. (a) [ ] I hereby tender cash/check in the amount of $ 370. W
NAME OF BANK: 4 fx7 oq� DAN is
CHECK NUMBER: 1 330
(b) [ ] I hereby file a Pauper's Affidavit, accompanied by a qualifying petition as prescribed in O.C.G.A. Sec. 21-2-132 (g), in
lieu of paying the qualifying fee.
NOTE: CANDIDATES FOR THE FOLLOWING OFFICES MUST FILE AN ADDITIONAL AFFIDAVIT IN
ACCORDANCE WITH THE LISTED CODE SECTION AND MAY HAVE OTHER REQUIREMENTS IN ORDER
TO BE QUALIFIED TO SEEK OFFICE. CANDIDATES SHOULD REVIEW THE QUALIFICATIONS FOR THE
OFFICE FOR WHICH THEY OFFER FOR ELECTION CAREFULLY.
CLERK OF SUPERIOR COURT
JUDGE OF THE PROBATE COURT
SHERIFF
CORONER
TAX RECEIVER
TAX COLLECTOR
TAX COMMISSIONER
O.C.G.A. § 15-6-50(b)(2)
O.C.G.A. § 15-9-2(a)(2)
O.C.G.A. § 15-16-1(c)(2)
O.C.G.A. § 45-16-1(b)(2)
O.C.G.A.§ 48-5-210(b)(2)
O.C.G.A.§ 48-5-210(b)(2)
O.C.G.A.§ 48-5-210(b)(2)