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<br />REQUIRED INFORMATION <br /> <br />OCCUP ATI~~ (PRESENT EMPLO~NT - PAID OR ~~Aio) I 0 l Lt 1'\ k.e r - "re~ ~\~ ,J ~il""" rtl%2..- <br />rTOVY\e. C~~ ",,""0"<" l.kJe"" LIt I leu d. vi <br />CDu.r\ ( r - - S:"'e. t'Y\~s C' n0W <br />OCCUPATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAl OR UNPAID) <br />'~ece()h~is+-I Adm,'",iSfr(li\re... Ass;sfarJ- - 5Ao.rlM Ik(~ hb L7C(f J!... () I AI 1, <br />r ~Ft;;1,~~' J "'"' Ou...Tr, L"ll. <br />A&m.Ih.'Sfr-tft-w As{.,s+tl,,\.} ~ Art 8cdtY"\..) Ph,1J. PSI('LcI~,tf- <br /> <br />:C'2>rn - 'ROLv'Yl - (;)Wi-( ,,~ A~$U(tulC!JL o-,,~,- <br /> <br />b 6 C.a / rn. tL - 'P,-o cya I'n,....u- _ 5 pe c- c.J .,,' ~ - 0 6rI ~.h.u "- <br />S S - Co\. . <br />EDUCATIONAL BACKGROUND (SCHOOLS A ITEND D, use attachment if needed) <br />Complete name of school- no acronyms Last grade level DiplooulDegree/Certificate Course of study (optional) <br />com leted AA BA as, MA PhO etc. <br /> <br /> <br />:l. <br /> <br />As. <br /> <br /> <br />Other: <br /> <br />PRIOR GOVERNMENTAL EXPERIENCE (ELECTED OR APPOINTED) <br /> <br />SD,^~ l\t"~v'~s;~ NQI'j klx-vhclOcL A.5$OC,'a.+'~ - B~J melh~,,- <br />a t'\ d N e /..0 s (e If-ec Gi ,'+vr <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 />1HA T I shall accept the nomination for the office indicated .above; <br />TI-IA T I shall qualify for said office if elected; and <br />1HA 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 />?- - f Y -()b <br /> <br />Candidate's signature I Date signed <br />~ -c:2'3 -0(, <br /> <br />WARNING: Supplying false information on HilS form may result in conviction of a felony with a fine of up to $100,000 and lor 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, wUess <br />the person first files a written withdrawal with the officer who accepted the filing (ORS 249.013(2)). <br /> <br />SEt 120RF.V.1I/01 ORS249.031 <br />