**All Fields are Required**
I understand that if appointed, I will serve in a voluntary capacity on this advisory board.
By my entering my typed signature below, I certify that the information on this application is true and complete.
I understand that false statements will be cause for denial of appointment.
I also understand that, if appointed, the State of Florida may require me to file a financial disclosure with the
Putnam County Supervisor of Elections within thirty (30) days of my appointment,
and each year thereafter, covering my term of appointment.