Agreement & Signature
By submitting this affidavit, I affirm that the facts set forth are true and complete. I understand that if any false statements, omissions or other misrepresentations made on this affirmation may result in my immediate dismissal. In the event I obtain the original check referred to above, I shall immediately mail to the Lake County Supervisor of Elections, P.O. Box 457, Tavares, FL 32778.