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NOTICE OF WILLINGNESS TO SERVE <br /> <br />TO: Janet LeViner, CMC, Superintendent of Elections <br /> City of Tybee Island, Chatham County, State of Georgia <br /> <br />I, the undersigned, being first duly sworn on oath, do depose and say that my name is: <br /> <br />_________________________________________________________________________; <br /> <br />that my residence address is:__________________________________________________; <br /> (Street) <br /> <br />__________________________________________________________________________; <br />(City) (County) (State) (Zip) <br /> <br />that my post office address is:_________________________________________________; <br /> <br />that my telephone number is:__________________________________________________; <br /> (Home) (Business) <br /> <br />that my email address is: ____________________________________________________ <br /> <br />that my profession, business, or occupation (if any) is:______________________________; <br /> <br />that I am an elector of the county of my residence eligible to vote; that the name of the office to <br /> <br />which I may be names is City Council Member. <br /> <br />That my date of birth is:____________________; that I have been a legal resident of the State of <br /> <br />Georgia for_________ years; that I am a citizen of the United States; that I have never <br /> <br />been convicted and sentenced in any court of competent jurisdiction for fraudulent violation of <br /> <br />primary election laws, malfeasance in office, or felony involving moral turpitude under the laws <br /> <br />of this State, and other State, or the United States, or, if so convicted, that my civil rights have <br /> <br />been restored; and at least ten years have elapsed from the date of the completion of the sentence <br /> <br />without a subsequent conviction of another felony involving moral turpitude; and that I will not <br /> <br />knowingly violate any provisions of the Georgia Election Code (O.C.G.A. Ch. 12-2), or the rules <br /> <br />or regulations adopted thereunder. <br /> <br />I understand that any false statement knowingly made by me in this Notice of Willingness to Serve <br />and Affidavit will subject me to criminal penalties as provided by law and I hereby request you to <br />cause my name to be placed on the ballots to be used in such election as a candidate for the office <br />I am seeking. <br /> <br />_____________________________________ <br /> (Signature) <br />NOTARY <br />Sworn and subscribed before me this _________ day of __________________ <br />Signature: _________________________________________________________ <br />My Commission Expires:_____________________________________________ <br /> <br />