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Home My WebLink AboutMatthew Miller Write-in Candidate Acceptance Form SEL 141 ' -01124 ORS 254648 2014 Write In Acceptance Deadlines Primary Election General Election July 7, 2014 December 19, 2014 All information must be completed or the form will be rejected. This filing is an ❑ Nomination (Election Filing Officer ❑ Secretary of State ❑ County Elections Official City Recorder (Auditor) Candidate and Nominee Information Name of Candidate First MI Last Suffix Now you would' like your name to appear on the ballot Suffix First j) MI Last /vI I Candidate Residence/Route Address Street Address City j State Zip Candidate Mailing. Address Street Address or PO Box State ZiCity p 4W Lr'ek ( Vlf 4 Cict' 0 Pvi Contact Information: Only one phone number is required. jWork Phone Home `Phone Cell Phone Fax Email Address Web Site, if applicable Office Information Office of: Raw o m m i s S l vn er- District, Position, County or City: pigchm 34 Multiple Nomination Information See 2014 Candidates Manual for default order List other nominations to be printed on ballot. Other nominations should be printed in what order? ❑ Default ❑ Specified: Occupation (present employment) If no relevant experience, None or NA must be entered. T { z Occupational Background (previous employment) If no relevant experience, None or NA must be entered. V 0 rip, Continued on the reverse side of this form SEL 141 8Y Educational Background (schools attended) If no relevant experience, None or NA must be entered. r Complete name of School (no acronyms) Last Grade completed Diploma/Degree/Certificate C rse of Study 0.y %t I t ~fL U4(kr 4 e t µ L Rn 1.1, 4 Educational Background (other) Attach a separate sheet if necessary. Prior Governmental Experience (elected or appointed) If no relevant experience, None or NA must be entered. 0 ►k,/ Assembly of Electors We swear or affirm the statements on this certificate are true and Not less than 1000 electors of the state, or Not less than 500 electors of the congressional district, or > Not less than 250 electors of the county or any other district for which the nomination is made, were present when the nomination was made The nominating convention was help in one day and lasted less than 12 hours. The candidate named on this certificate received the highest number of votes for the office indicated from the assembly and is the nominee of the assembly (ORS249.735). Signature of Presiding Officer Signature of Secretary Printed Name of Presiding Officer Printed Name of Secretary State of OREGON, County of Signed before me on 20 by Subscribed before me this dayof 20 Judge or Notary Public - State of Oregon Campaign Finance information (not applicable to candidates for federal office) Candidate Committee ❑ 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, I must follow the requirements detailed in the Campaign Finance Manual. No, but will be filing a Statement of Organization for Candidate Committee (SEL 220). I El By signing this document I hereby state that: I will accept the nomination for the office indicated above I will qualify for said office if elected If nominated for a partisan office, I am not, and have not been, a member of a political party since February 27, 2014 and > all information provided by me on this form is true to the best of my knowledge A Warning Supplyingfalse 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 or at the same election. Unless the person has withdrawn from the firs filing, all filings are invalid. (ORS 249.013 and ORS 249.170) Candidate's Signature Date Signed For Office Use Only Initials Write-In Candidate Acceptance Form SEL 141 , rev 01114 ' ORS 254 548 2014 Write-In Acceptance Deadlines Primary Election General Election July 7, 2014 December 19, 2014 8 All information must be completed or the form will be rejected. This filing is an ❑ Nomination 04,Election Filing Officer ❑ Secretary of state ❑ County Elections Official City Recorder (Auditor) Candidate Nominee Information and Nominee Information Name of Candidate First MI Last , I Suffix ► C" Q w How you would like your name to appear on the ballot First a MI Last Suffix Candidate Residence/Route Address 1~/ 4l Street Address City State Zip li G r ?,e. w' Wick AAkPA of, gv1o Candidate Mailing Address Street Address or PO Box City State Zip UA0 L) m'.' kupi bw S 0K 915 Contact Information: Only one phone number is required. Work Phone p Home Phone Cell Phone Fax '1 _0-24-1-105 Email Address Web Site, if applicable tt Q r Office Information Office of: " ommissiTAer- District, Position, County or City: -h M di 4 O-A Multiple Nomination Information See 2014 Candidates Manual for default order List other nominations to be printed on ballot. Other nominations should be printed in what order? ❑ Default ❑ Specified: Occupation (present employment) If no relevant experience, None or NA must be entered. At C."L Occupational Background (previous employment) If no relevant experience, None or NA must be entered. Jom, Continued on the reverse side of this form SEL 141 NOV 2 ~ ?Old BY