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<br />() <br /> <br />() <br /> <br />REQlJIRED INFORMATION <br />OCCUPATION (PRESENT EMPLOYMENT - PAID OR UNPAID) <br /> <br />~ve-e-,\Sc'~ <br /> <br />~tA-nVe <br /> <br />OCCUPATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAID OR UNPAID) <br />- Ac-D ACteNcy ~ee. <br />~f")1 -nit ~VVS~ At> ~les <br /> <br />EDUCATIONAL BACKGROUND (SCHOOLS ATIENDED, use attachment if needed) <br /> <br />Complete name of school- no llC1'Ol\YD1fI Last grade level DiploinaJDegree/Certificate Course of study (optional) <br />com leted BA, BS, MA PhD etc. <br /> <br />tAW'-~\1\;1t~ <br /> <br />~6kl <br /> <br /> <br /> <br />tmcAL ?C4' <br /> <br />Other: <br /> <br />PRIOR GOVERNMENTAL EXPERIENCE (ELBCfED OR APPOINTED) <br /> <br />Evl-(a~ OTY ~b<aer_ ~U;L(~ <br />. L~ C.eu.~ ~~ lr> ~JoCAc\{ CNTe~ ~D <br /> <br />NOTE: This information is a matter of public record and may be published or reproduced. <br /> <br />By signing this document, I hereby state: <br />THAT I shall accept the :nomination for the office indicated flbovei <br />THAT I shall qualify for said office ifelectedi and <br />THAT all information provided by me on this f011l\ including my occupation, educational and occupational background, and prior <br />governmental experience, is true to the best 0 my knowledge. <br /> <br /> <br />12/IS/VS- <br /> <br />W G: pplying false information on this form may result in conviction of a felony with a fine of up to $100,000 and/or prison for up to fiye <br />years. (ORS 260.715). <br />No person shall file a nominatingpetitfon or qeclaration of candidacy for more than one lucrative office before the date of the primary election, unless <br />the person fust files a written withdrawal with the officer who accepted the filing (ORs 249.013(2)). <br /> <br /> <br />o(p <br /> <br />SEL 120 REV. 11/01 ORB 249.031 <br />