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Statement of Organization for Chief Petitioner Committee SEL 222 rev 12/07: ORS 260.118 Filing a New Committee: This form must be completed and filed by chief petitioners of an initiative, referendum or recall petition within 3 business days of first receiving a contribution or making an expendTture and no later than the date the petition is approved for circulation. For a recall petition, it must be filed with the prospective petition. The "Original" box should be marked. A date stamped copy of this form, which includes the committee's identification number, will be returned to the treasurer as an acknowledgment of the filing. Chief Petitioners: A chief petitioner committee must list all chief petitioners of the petition. Amending Information on this Form: Any change in the information on this form must be filed within 10 days of the cha~ge. To notify the Elections Division of a change in information, submit this form, completed in its entirety, and mark the "Amendment" box. Discontinuing: A chief petitioner may discontinue their committee by disclosing all transactions that achieve a zero balance and filing a completed SEL 222 with the "Discontinuation" box marked. Discontinuation of a state initiative or referendum chief petitioner committee prior to the deadline for submitting signatures for verification can occur only if the petition is withdrawn. please type or print legibly in black ink This filing is an: o Original OAmendment o Discontinuation J, name of committee If changing committee name, please include former name. abbreviation or acronym committee address street/route, city, state, zip code; no post office box numbers campaign phone name of treasurer o Mr 0 Ms mailing address for committee correspondence work phone home phone fax email address name of alternate transaction filer OMr OMs mailing address for alternate transaction filer street/route, city, state, zip code email address type of chief petitioner com mittee mark both type of petition AND jurisdiction type of petition Olnitiative o Referendum o Recall jurisdiction o State* OCounty OCity OSpecial District date prospective petition filed mm/dd/yy * date of election (only required for state petitions) mm/dd/yy continued on the reverse side of this form SEL 222