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<br /> REQUIRED INFORMATION <br />OCCUPATION (PRESENT EMPLOYMENT - PAID OR UNPAID) , <br /> L-ey,l~LA,,"e. APFA,lLS f 'XT' rVJINlJqeA <br /> (;J\'\~ pvD <br />OCCUPATIONAL BACKGROUND (pREVIOUS EMPLOYMENT - PAID OR UNPAID) <br /> . <br />EDUCATIONAL BACKGROUND (SCHOOLS A'ITENDED, use attachment if needed) <br />Complete name of school- no acronyms Last grade level DiploinaJoegreeJCertificate Course of study (optional) <br /> comDleted (AA BA, BS, MA, PhD, etc.) ~!r.P <br />UtJtrl>i2.$ ('t(,( Or- CJ~tN MA e.Nlf//J.t,'1 t 6N~j , <br /> PlJWN~Nt, i ~()Ut!,Y <br />Ot-llJ'FL\ ~"r-l ~ ~CALJfoIWIA <<t fJGl.t$..e'{ "BA pc:.l..r2\otL- ECu.rr,..,y <br />Other: " <br />PRIOR GOVERNMENTAL EXPERIENCE (ELECTED OR APPOINTED) <br /> ~c;=N~ ~v~&f CQ/vt/w't ?.of~ LAVe (eJ lV'TY <br /> Co /vlJYt tift aN of <br /> p v tWN ~ et..\l\. c-c:> <br /> NOTE: This information is a matter of public record and may be published or reproduced. <br />By signing this document, I hereby state: <br />THAT I shall accept the 'nomination for the office indicated flbove; <br />THAT I shall qualify for said office if elected; and <br />THAT 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 /> 03L- g- j;:; ~ J.z. /2-2--0)' <br />Candidate's signature Date signed <br />WARNING: Supplying 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 fi"e <br />years. (ORS 260.715). <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 (ORs 249.013(2)). <br /> . <br /> <br />SEL 120 REV. 11/01 OllS 249.031 <br />