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<br />o <br /> <br />O' <br /> <br />REQUIRED INFORMATION <br />OCCUPATION (PRESENT EMPLOYMENT - PAID OR UNPAID) <br />m AlLIe -c.J- ?L'f S; J ~ v + "24 ^,",-o'; /J;nc,{..t'c...r1 <br /> <br />occur ATIONAL BACKGROUND (pREVIOUS EMPLOYMENT - PAID OR UNPAID) <br />SP~ I 'cJ It. ().- <-R ~_c..S ;dc...J + - F":'trJ.J-;r.... hit sJ-"iL Z~vk. <br /> <br />EDUCATIONAL BACKGROUND (SCHOOlS ATTENDED, use attachment if needed) <br /> <br />Complete name of school. no acro~s Last grade level DiplomalDegreelCertificate Course of study (optional) <br />com leted AA BA BS MA PhD etc. <br /> <br />tA ~tuc~s::-l- <br /> <br /> <br />".J <br /> <br /> <br />s <br /> <br />d I.~ l:v..1 S-(!.I~'" <br /> <br />Other: <br /> <br />PRIOR GOVERNMENTAL EXPERIENCE (ELECTED OR APPOINTED) <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 />lHA T I shall accept the nomination for the office indicated !lbove; <br />TIIA T I shall qualify for said office if elected; and <br />lHA T 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 />./ oI~--;:::=: <br /> <br />signature <br /> <br />/~-&/ ex!. e:f'~<--~ <br /> <br />WARN : Supplying false information on this form may result in conviction of a felony with a fine of up to $100, <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)). <br /> <br /> <br />II~ I1J Jd <:, <br />Date signed " <br />~ ;;J.,/ o~ <br /> <br /> <br />SBL 120 REV. 11/01 OIlS 249.031 <br />