CANDIDATE PETITION

Note:
! All information on this form, including your signature, becomes a public record upon receipt by the Supervisor of Elections.
! Under Florida law, it is a first degree misdemeanor, punishable as provided in s. 775.082 or s. 775.083, Florida Statutes, to
knowingly sign more than one petition for a candidate, a minor political party, or an issue. [Section 104.185, Florida
Statutes]
! If all requested information on this form is not completed, the form will not be effective as a Candidate Petition Form.

I, the undersigned, a registered voter

(Please print name as it appears on voter information card)

in said state and county, petition to have the name of Patricia Sullivan
placed on the Primary / General Election Ballot as a: !
✔ Party Republican
(Name of political party)
! Nonpartisan ! No Party Affiliation (formerly independent)

United States Congress, 8th Congressional District of Florida

Candidate for the office of: _____________________________________________________________________________________
(Include district, circuit, group, seat number, if applicable)

Date of Birth Voter Registration Number Residence Address

or

City County State Zip Code

Signature of Voter Date Signed (to be completed by

Voter)

DS-DE 104 (Eff.10/07)

Thank you for taking the time to complete a petition to put Patricia Sullivan on the ballot for the Primary Election on August 24, 2010.
Signing a petition does not obligate you to vote for Patricia. You are simply asking the State of Florida to include Patricia on the Primary
ballot. The Primary Election is held to select one person to run against other parties' nominees.

The State of Florida places certain requirements on petitions. In order to sign a petition for Patricia Sullivan you must fulfill both of the
criteria below:

1 - You must live in Florida's 8th Congressional District (Alan Grayson (D) is the incumbent). If you are not sure of your Congressional
district, please check the following web site:

http://www.house.gov/Welcome.shtml

In the upper left corner, just under the House of Representatives logo, you can enter your Zip + 4 to find your Congressional district.

2 - You must be a registered voter and eligible to vote. Any voter, regardless of party, may sign a candidate petition.

You can easily become a registered voter by visiting your county Supervisor of Elections office. You may also be able to register at your
county's web site.

If you meet these criteria, simply print the form, complete all the fields, sign it, and send it to this address:

Patricia Sullivan for Congress

P.O. Box 997
Eustis, FL 32727-0997

Alternatively, you may send a scanned copy to: patricia@PatriciaSullivanForCongress.com

Thanks again for your help!