FEB 0 6 2017
Candidate Filing
SEL 190
rev 01/16
ORS 255.235
District
8
All information must be completed or the form will be rejected.
D Amendment
~zr original
This filing is an
Office Information
Filing for Office of:
Filing Information
~ Filing with the required $10.00 fee
0
Prospective Petition
Candidate Information
Name of Candidate
.
tU;fl
c:/
How you would like your name to appear on theballot
Candidate Residence/Route Address
Street Address
f
o3
Fax
Email Address
Web Site, if applicable
Occupation (present employment) If no relevant experience, None or NA must be entered.
..• ·
Occupational Background (previous employment) If no relevant experience, None or NA must be entered.
Continued on the reverse side of this form
SEL 190
~~.!J~~tibnal
Background (schools attended) If no relevahtexperience, None or NA must be entered.
Complete name of School (no acronyms)
Last Grade completed
Diploma/Degree/Certificate
Course of Study
VA
Educational Background (other) Attach a separate sheet if necessary.
,~.~~ip,\Governmental Experience (elected or appointed) If no relevant experience, None or NA mt~st be entered.
1
:~~~l'l)palgrrlilnaru:e Information (not applicable to candl~atesfor federal office)
0
Yes, I have a candidate committee.
~No, I do not expect to spend more than $750 or receive more than $750 during each calendar year. I understand I must still keep
records of all campaign transactions and if total contributions or total expenditures exceed $750 during a calendar year, 1must
follow the requirements detailed in the Campaign Finance Manual.
0
No, but will be filing a Statement of Organization for Candidate Committee (SEL 220).
By signing this document, I hereby state that:
.~
~
I will qualify for said office if elected
all information provided by me on this form is true to the best of my knowledge
.warr)ing
•· Supplying false inf()rmation on this form may result in conviction of a felony with a fine of up to $125,000 and/or prison for
up to 5 years. (ORS 260.715). A person may only file for one lucrative office at the same election .
.· · (dlRS ,2.49.013 and ORS 249.170)
{:2 -b~/ 7
Candidate's Signature
For Office Use Only
Initials
Date Signed
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'------:-6o
\v~
Candidate Filing
SEL 190
MAR 1 5 1017
rev 01/16
ORS 255.235
District
C) All information must be completed or th~/ will be rejected.
0
~Original
This filing is an
'Office Information
Amendment
.·
..C:'
D If- Y c....-p (l.L f_ os., --cJ D /V ~
District, Position or County:
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Filing for Office of:
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l ~'1'" pos
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Filing Information
}1:Filing with the required $10.00 fee
0
Prospective Petition
Candidate lnfQrmation
Narne of candidate
.
First
fZo f3 e e-'(
.
Title
How you would like your name to appear on the ballot
Candidate Residence/Ro.ute Address
Street Address
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Ca~didate
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, J Home Phone
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sera
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Malli'!_g ~ddress and Contact lnformati!?n: Only. one phone number is required.
Street Address or PO Box
Work
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I City
I State
fc (.41"1 A- IN //All<.
C;<
I Cell Phone
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9??dl
J Fax
,I Web Site, if applicable
Emae~res F tvt f't;-f (~· t?~A!L • Coj'h
Occupation (present employment) If no relevant experience, None or NA must be entered.
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Occupational Background (previous employment) If rio relevant experience, None or NA must be entered.
Continued on the reverse side of this form
.··}
SEL 190
~
-
~------~--
Edt.tcational Bac~tOI,Ind (schools attended) If no relevant experience, None or NA must be entered.
Educational Background (other) Attach a separate sheet if necessary.
t:J~i6f~6l,erh,.,~ntal £xperience (elected or appointed) lfno relevant experience, None or NA must be entered.
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Oft
,,.c~mpaign
Finane~ lnformatlo~
(not applicable to candidatesfor federal office)
'
.
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0
'
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,',
Yes, I have a candidate committee.
~No, 1do not expect to spend more than $750 or receive more than $750 during each calendar year. I understand I must still keep
records of all campaign transactions and if total contributions or total expenditures exceed $750 during a calendar year, I must
follow the requirements detailed in the Campaign Finance Manual.
0
No, but will be filing a Statement of Organization for Candidate Committee (SEL 220).
By signing this document, I hereby state that:
~
~
I will qualify for said office if elected
all information provided by me on this form is true to the best of my knowledge
~\~~ f.; :~;~~~~false
·,.;
information on this form may result in conviction of a felony with a fine of up to $125,000 and/or prison for
up to 5 years. (ORS 260. 715). A person may only file for one lucrative office at the same election.
(ORS 249.013 and ORS 249.170)
Candidate's Signature
Date Signed