State of Florida
County of
Before me, an officer authorized to administer oaths, personally appeared (name) , to me well known, who, being sworn, says that he or she is the (title) of the (name of party) (state or specified county) executive committee; that the executive committee has not made, either directly or indirectly, an independent expenditure in support of or opposition to a candidate or elected public official in the prior 6 months; that the executive committee will not make, either directly or indirectly, an independent expenditure in support of or opposition to a candidate or elected public official, through and including the upcoming general election; and that the executive committee will not violate the contribution limits applicable to candidates under s. 106.08(2), Florida Statutes.
(Signature of committee officer)
(Address)
Sworn to and subscribed before me this day of, (year) , at County, Florida.
(Signature and title of officer administering oath)
Fla. Stat. § 106.087