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<br />occupation oT candidate <br /> <br />employer's name <br /> <br />city and state of employer <br /> <br />o self-em played <br />o not em played <br /> <br />nam e of office sought Include county, position, department or zone number. if applicable <br /> <br />candidate election activity <br /> <br />o Primary 20_ <br /> <br />o General 20_ <br /> <br />OOther election date: <br /> <br />political party affiliation choose one iffiJjng for a parr;san office <br /> <br />OConstitution <br />o Republican <br /> <br />o Democratic <br />o Nonaffiliated <br /> <br />o Independent Party <br />o Working Families Party <br /> <br />o libertarian <br /> <br />o Other: <br /> <br />o Pacific Green <br /> <br />':-,;"'~,::J~";;~:~"'t>'~-~"::~'S_:: - ~-- -~--~ - -- --~ -_.~---~-~ - -- ---~ -- ------ - - - ~- =- -. ~ -- -::- ~-- --.- -- ~:_---=--:::.------= ----:., <br /> <br />Osupports or opposes multiple candidates and measures (If this is marked there is no requirement to name the <br />candidates or measures.) <br /> <br />Osupports specific measures or recall <br /> <br />measure number(s}: <br /> <br />candidate(s) being recalled: <br /> <br />Oopposes specific measures or recalls <br /> <br />measure number(s): <br /> <br />candidate(s) bein recalled: <br /> <br />If the committee has more than one director, attach a list of additional directors and include all the information required on the form <br />for each director.The candidate should not be designated as a committee director. A committee director is not required. <br /> <br />.J, name of committee director <br /> <br />address including zip code <br /> <br />phone number <br /> <br />occupation <br /> <br />employer's name <br /> <br />city and state of employer <br /> <br />o self-employed <br />o not em played <br /> <br />I <br /> <br /> <br />- - <br />- - - ~- - - - - - - - <br />~..... _ ~ -. :r- -=- __ ~~ ~_ ----=--_ --..___ ~ ~ -=--.=--_ ~_- _~ - _ =-_ _ ~ _-_~~- ~__~~. =-~-_-=--=--_~ - _=--_ _ ;::::.... -.=-_----"__z__-_....:::::j:l...___=-_ =---= "'--= -- - -..- --~~- =---= -_ _--=----_ -=-~--==--~ 'U 1 <br /> <br />~ _ -............... _ +-=-- ~ .... -..... ...--- 7 _ -- _ -- _ _ -- &-- _ _ ~ _ ~ _ _ _ -- ~ _ _ _ _ ~.- --- _ _ _ _ _ ~ -- _ -- _ _ _ ~ _ _ _ _ _ I <br />- - -- - - . - - - -- - - ....... . - - - - - --' - -- -. - ... . . - - - - - . . . ..... -. --------., <br /> <br />Attached is a Campaign Account Information form (SEL 223) <br /> <br />Oyes <br /> <br />o no <br /> <br />J, signature <br /> <br />By signing this document I acknowledge that I am personally liable for any penalties imposed under ORS chapter 260 and <br />attest that the information on the form is true and correct. <br /> <br />candidate's signature <br /> <br />date signed <br /> <br />treasurer's si nature if different than candidate <br /> <br />date signed <br /> <br /> <br />II <br /> <br />for office use only <br /> <br />initials <br /> <br />committee 10 number <br /> <br />office number <br /> <br />candidate ID number <br /> <br />date SEL 223 received <br /> <br />date acknowledgment sent <br /> <br />- - - - - - - - - - ~ ~ - --- - - -=- ~ - - ----- - --- --- -----=- --=-=--=- ----= -=-=-- -- -=------=- --== ---=-==-=-- -=-=-----======~ _.:- =======--====- <br /> <br />=- ----- - --- - - -=-- - = -- - - - - ~ - - - ~ - - - - - - <br />-- --~---~ =-- ----=--- -=-- - ~ ==- -- - - --=-- - - -=- - - -- <br /> <br />- <br />