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<br />REQUIRED INFORMATION <br /> <br />OCCUPATION (PRESENT EMPLOYMENT - PAID OR UNPAID) , <br />L...-C"'4l)1.J\"',\\I& APFAI(l~ if T'T' r"'AINA4EJ... <br />~ v"D <br />OCCUPATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAID OR '(,JNPAID) <br /> <br />EDUCATIONAL BACKGROUND (SCHOOLS ATfEND~D, use attachment if needed), <br /> <br />Complete name of school-no acronyms Last grade level DlplomalDegreelCertificate <br />COM leted BA US PhD etc. <br /> <br />UtMi12-~t--Zt1 Or 0 M\J <br />. b r:.CAw~1lH11\ f(t ~Ut$.e'l <br /> <br /> <br /> <br />Other: <br /> <br />PRIOR GOVERNMEN'rAL EXPERlENCE (ELECfEDORAPPOINTED) <br /> <br />~~, e- "2>,' ~~6.:1 CO_I\1)t4~if"'1eE. <br />. Q - oF- !.Ave {C)vNTY <br />FvtW)J ~ etLV\.C,C5 CoNl/'l'H1f t(3N <br /> <br />NOTE: This information is a matter of public record and may be published or reproduced. <br /> <br />By signing this document, I hereby state: <br />TIiAT I shall accept the :nomination for the office indicated !"bove; <br />TIiAT I shall qualify for said office if-elected; and <br />TIiAT all information'provided by me on this form, Including my occupation, educational and ~upational background, and prior <br />governmental experience, is true to the best of my knowledge. <br /> <br />Candidaw.m~ q. ~ ~/~ . <br /> <br />12.~ q- O~ <br />Date signed. <br /> <br />W ARNlNG: Supplying false information on this fonn may result in conviction of a felony with a fine of up fa $100,000 and/or prison for up to fiye <br />years. (ORB 260.715). ' <br />No person shall file a nominatlngpetitlon or qeclaration of candidacy for more than one lucrative office before the date of the primary election, unles <br />the person first files a written withdrawalwith the officer who accepted the filing (ORs 249.013(2)). '. <br /> <br />SEL 120 REV, 11/01 ORS 249.00 <br />