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<br />REQUIRED INFORMATION
<br />OCCUPATION (PRESENT EMPLOYMENT - PAID OR UNPAID) "
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<br />occur ATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAID OR UNPAID)
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<br />EDUCATIONAL BACKGROUND (SCHOOLS ATI'ENDED, use attachment if needed)
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<br />Complete name of school- no acronyms Last grade level DiplomalDegreelCertificate Course of study (optional)
<br />com leted AA BA, BS MA PhO etc.
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<br />A A G-eYUraJ
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<br />Other:
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<br />PRIOR GOVERNMENf AL EXPERIENCE (ELECTED OR APPOINTED)
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<br />RECEIVED
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<br />FEB 2 1 2006
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<br />CITY RECORDER
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<br />NOTE: This information is a matter of public record and may be published or reproduced.
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<br />By signing this document, I hereby state:
<br />THAT I shall accept the nomination for the office indicated !Ibove;
<br />TI-lA T 1 shall qualify for said office if elected; and
<br />THAT 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,
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<br />\ d- - ~'3 - 0 6
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<br />Date signed
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<br />c1-dl-O&
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<br />WARNING: Supplying false ' nnation on this form may result in conviction ola felony with a fine of up to $100,000 and I or prison for up to five
<br />years. (ORS 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 (ORs 249,013(2)).
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<br />sa 120 REV. \1/01 ORS249,031
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