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Petition for Nonpartisan Nomination Signature Sheet petition ID o One or More 0 No petition circulators will be paid. mark one This is a candidate nominating petition. Signers of this page must be active registered voters in the following county: Note to Candidate: Petition signatures must be verified before the petition can be filed with the filing officer. Submit the petition in ample time for the process to be completed before 51?m on the filing deadline day. ,J, candidate's name offi ce dIstrict. position orzone number If applicable To the Secretary of State of Oregon/County Elections Official/City Recorder, We, the undersigned voters, request the candidate's name printed above, for nomination to the office indicated, be placed upon the appropriate ballot at the next election following the filing of this petition. signature* date signed* mm/dd/yy print name* residence or mailing address* street, city, zip code precinct # (optional) \~.~ ~-_-,-~-_-.:- _~~- =-=-~=-- ~----=~-=.~~ __-~ _~--'" :::==--__~- '"~~ _---=;-:~--~~;;c.~~-~-..o._=__='"=-~_.:=_~ ~-=-~ ~-=-~~~-:.~-~~.;~~~-~~::;;::::::--=-~.;::-~~~.:..~-=-=--=---:.-.::.;--=~--====,,:~-===-~~~~~-=-~=~--~~~-~~ . - R . . III * Signature must only be completed by the signer. Circulators may not complete, change or obscure the signer's signature, date signed, printed name or address information, unless the signer initials the change. An exception is allowedzfor a circulator to complete or change information (other than the signature) if requested to do so by a disabled signer. circulator certification This certification must be signed by the circulator! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheetl and I believe each individual is an elector qua/fied to sign the petition. (ORS 249.061) I also certify that compensation I receivedl if an)!, was not based on the number of signatures obtained for this petition. Warning! Falsely signing this statement may result in conviction of a felony with a fine of up to $1251000 and/or prison for up to 5 years. (ORS 260.715) circulator signature date signed mm/dd/yy printed name of circulator county elections official certification J hereby certify o::ignatures on this petition are those of active registered voters in circulator's addre-ss street, city, zip code County, Oregon. signature of county elections officiaf SEL 121 rev'f08 ORS249,07Z date certified mm/dd/yy sheet number