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<br />o <br /> <br />C) . <br /> <br />REQUIRED INFORMATION <br />OCCUP AnON (PRESENT EMPLOYMENT - PAID OR UNPAID) <br />l)l~~\o~ -t>'~~\)~~(UL \b~\~(\.. <br /> <br />occur ATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAlO OR UNPAID) <br />-r:.~ "5~~~'-"- \t> ~\~ ~ \ '-\ ~~ <br />\.\~~~~\. ~~~~\.11>\)~~~~ ~~~ <br /> <br />~ "\ 'i.u:.1\..) <br /> <br />EDUCATIONAL BACKGROUND (SCHOOLS ATIENDED, use attachment if needed) <br /> <br />Complete name of school- no acro~s Last grade level DlplomalDegree/Cerlificate Course of study (optional) <br />com leted AA BA BS MA PhO etc. <br /> <br /> <br /> <br />Other: <br /> <br />PRIOR GOVERNMENTAL EXPERIENCE (ELECTED OR APPOINTED) <br />~.~Ck~ ~~~\~\~~i~~' ~~l Q,\)~~ <br />~~ \~--\;~'\~ . . <br />~~~ ~ \f ~~. ~~, ~ ~ ~, '\\'V\\l~~h ~~ l,-~~ ~'+'\~)~~ I~ ()-~~ <br /> <br />~~ ~.~. ~~\..~~ \l\\.\..~~ ~t'<)~~~~-'\~\.. \~"6(:)-\li~ <br />~~~~ L~~~~""'\. ~\)-bN) \)\ "\ ~~h \-Ot'\t.... \'\1 Q.. <br />~. 'lV-\1~<'.. ~.~.~"~9 ~~"\ ~,~ ~ \}~~~~~D (\ '\. ~1\\j\'V!\.... o.~ <br />\4:>v'\C-'~",') IJ '\ ~""L~ ,",v '\ '\J <br />~~ ~~ '\b~ "J'''~\\\}rq\.. ~~\ \1\\'~~ \~~\o"'\~~"8 <br />"'~ ~'\~~c;>\..o~o'\ "S ~~ ~ ~ ~\\v.- <br /> <br />\'1n-\\'\\) <br /> <br />, <br />NOTE: This information is a ma r of public record and may be published or reproduced. <br /> <br /> <br />By signing this document, I hereby state: <br />TIlAT I shall accept the nomination for the office indicated ilbove; <br />nlA T I shall qualify for said office if elected; and <br />TIIA T all information provided by me on this form, including my occupation, educational and occupational background, and prior <br />governmental experience, is true to the best of my knowledge. <br /> <br /> <br />WARNIN : Suppl . g ise 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 five <br />years. (ORS 60.715). <br />No person shall file a nominating petition or declaration of candidacy for more than one lucrative office before the date of the primary election, unless <br />the person first files a written withdrawal with the officer who accepted the filing (OKS 249.013(2)). <br /> <br /> <br />SI!L 120 REV. 11/01 OIlS 249.ln1 <br />