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<br />REQUIRED INFORMATION <br />O:CUPATION ~ EMPLOYMENT -PAIDOR UNPAID) <br />vi 7-Ij l-OUnCl/tJr; hOf't)emaJ::.eY- ; vol kJ1 fees- <br /> <br />O:CUP ATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAID OR UNPAID) <br />ed-t'fvr <br />O1Ycc4vr Of- J1.0h pnlf,-f pr9a.nrz-lJ..:h'tTY) <br />[,.-0 - OYdin~f7;r: l.tv1c VcY>fur~ fi:;YlUY) <br />UmfhiJl-cc Actmihl~~fvr; Sm-fc ~qisla.fu.rc 2.001 <br /> <br />EDUCATIONAL BACKGROUND (SCHOOLS ATI'ENDED, use attachment if needed) <br /> <br />Complete name of school- no acmn.yms Last grade level DiplomalDegreeJCertificate Course of study (optional) <br />com leted BA, B5 MA PhD etc. <br /> <br />Bft jOilrnui~ <br /> <br /> <br />r;)- <br /> <br />Other: <br /> <br />PRIOR GOVERNMENTAL EXPERIENCE (ELECfED OR APPOINTED) <br />Gw-rOrf u-fy [A)l/nc//orj wtJ.,rd ~ <br />T;:kqenc Budqci UJrnm/UC6' 4fJP/)J~ twlLu <br />Member-- Chtv1-cr, Rt:v Jew Ta5/C FtJr-cc.-- <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 />lHAT I shall accept the nomination for the office indicated !lbove; <br />TIIA T I shall qualify for said office if elected; and <br />TIlAT all information provided by me on this form, including my occupation, educational and occupational background, and prior <br />governmental experience, is true to the best of my knowledge. <br /> <br /> <br />/ ;} . d'/ ' 0 ~ <br /> <br />Date signed <br /> <br />ING: Suppl tion on this form may result in conviction of a felony with a fine of up to $100,000 and/ or prison for up to five <br />y . (ORB 260.715). <br />No person shall file a nominating petition or declaration of candidacy for more than one lucrative office before the date of the primary election, unless <br />the person first files a written withdrawal with the officer who accepted the filing (ORB 249.013(2)). <br /> <br />SEL 120 REV. 11/01 ORS 249.031 <br />