Notes: - All information on this form becomes a public record upon receipt by the Supervisor of Elections.

- It is a crime to knowingly sign more than one petition for a candidate. [Section 104.185, Florida Statutes]

- If all requested information on this form is not completed, the form will not be valid as a Candidate Petition form.


Print Name as it Appears on Voter Information Card

the undersigned, a registered voter in said state and county, petition to have the name of Bobby Dubose placed on the Primary/General Election Ballot as a Democratic Party candidate for the office of U.S. House of Representatives - District 20

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