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<br />required information (if no relevant information, list IINone") <br />t OCGupatlon present empToyment - palO or unpaid <br /> <br />occupatlonaToacKgrouna prevIous employment - paId or unpaId <br /> <br />.J, educational background schools attended, use attachment ifneeded <br /> <br />I - - -- " ~~, - -,- - a~~. - ~~ < - -~- ~- ..- -~~- ~ ~ - - "'--'= ~-~~='----~~=-~-- ----=---=-=--=-=--=--=-- - '! <br /> <br />completed <br /> <br />_ ______(~A~BA,BS,MA~PhD~etc) <br /> <br />, "': _~.... ~-~ ===- _ ___ ___ _:::-~___-=-::::;; -== _==___~_ --=- ~-:::: ;:::___=-_-_ =-_ __-.:....==:.. _ _ ==--~ ~~ ---==~ _- -:----:--=-::::: -=-- --= _~ __:;:::-- ::-------=-~~_ ~-. - - ~- _--=- _ ... _.L --:-,..."""""'- _ ~ -=-~-~_:...:...~_=~=-.=-=~~ <br /> <br />J, prior governmental experience elected or appointed <br /> <br />By signing this document, I hereby state: <br />--+ that I will accept the nomination for the office indicated <br />-+ that / will qualify for said office if elected <br />-+ that a/J information provided by me on this form, including my occupation, educational and occupational background, and <br />prior governmental experience, is true to the best of my knowledge <br /> <br />Check the appropriate box (not applicable to candidates for federal office - US Senate and US Representative): <br /> <br />o By marking this box, I certify I do not have an existing candidate's committee and I do not expect to spend more than $300 <br />or receive more than $300 during each calendar year. I understand I must still keep records of all campaign transactions <br />and if total contributions or total expenditures exceed $300 during a calendar year, I must follow the requirements detailed <br />in the 2008 Campaign Finance Manual. <br /> <br />o By marking this box, I certify that I have already filed or will soon file a Statement of Organization for Candidate <br />Committee (SEL 220). For detailed instructions, see the 2008 Campaign Finance Manual. <br /> <br />candidate's signature <br /> <br />date signed <br /> <br />This information is a matter of public record and may be published or reproduced. <br /> <br /> <br />.-ng <br />lying false information on this form may result in conviction of a felony with a fine of up to $125,0, <br />for up to 5 years. (ORS 260.715) A person may only file for one lucrative office at the same electiC. the <br />n has withdrawn from the first filingl all filings are invalid. (ORS 249.013(3)) <br /> <br />I <br /> <br />for office use only <br /> <br />initials <br /> <br />candidate rD number <br /> <br />receipt number <br /> <br />candidate committee 10 number <br /> <br />office number <br /> <br /> <br />- <br />