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HomeMy WebLinkAboutTheo White Completed Candidate Filing SEL 101/15 rev 09 9Major Political Party or Nonpartisan ORS 249.031 Filing Dates Candidate Filing State Voters'' Pamphlet Candidate Withdrawal Primary Election May 17, 2016 Filed electronically using ORESTAR First Day to File September 10, 2015 January 18, 2016 Last Day to File March 08, 2016 March 10, 2016 March 11, 2016 General Election November 8, 2016 First Day to File June 1, 2016 July 11, 2016 Last Day to File August 30, 2016 August 30, 2016 September 2, 2016 8 All information must be completed or the form will be rejected. This filing is an Original ❑ Amendment L Filing Officer ❑ Secretary of State ❑ County Elections Official City Recorder (Auditor) Office Information Filing for Office of: c District, Position or County: 0- Party Affiliation: ❑ Democratic Party ❑ Republican Party Independent Party onpartisan Incumbent Judge: ❑ Yes ❑ No C Nondisclosure on file Paying by Declaration or Petition: ❑ Declaration, with the required fee Office Filing Fee Office Filing Fee United States President n/a District Attorney $50 United States Vice President n/a County Judge $50 United States Senator $150 MSD Executive Officer, MAD Director $100 United States Representative $100 MSD Councilor $25 Statewide Offices $100 County Office $50 State senator or Representative $25 City Office Set by charter or ordinance Circuit Court Judge $50 Justice of the Peace n/a Prospective Petition Petition circulators will be paid ❑ Yes M No Candidate Information Name of Candidate First Mi Last Suffix Title Now you would like your name to appear on the ballot M eD Candidate ResidencetRoute Address Street Address City State Zip County t 0 N 1Mailing Address Street Address or PO Box City State zip o kk-- 7 s~ Continued on the reversed side of this form Contact Information: Only one phone number is required. Work Phone Home Phone Cell Phone Fax MbSit~e, Sv $ 00,Email Address if applicable 1A 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. co", Educational Background (schools attended) If no relevant experience, None or NA must be entered. complete name of School no acronyms) Last Grade completed Diploma/Degree/Certificate Course of Stud Educational Ba round (other) Attach a separate sheet if necessary. Prior Governmental Experience elected or appointed) If no relevant experience, None or NA must be entered. eJ. Campaion Finance Information (not applicable to candidates for federal office) Candidate Committee ❑ Yes, I have a candidate committee. KNo, 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). By signing this document, l hereby state that. -4 1 will accept the nomination for the office indicated above 1 will qualify for said office if elected a all information provided by me on this form is true to the best of my knowledge and no circulators will be compensated based on the number of signatures obtained by the circulator on a prospective petition For Major Political Party Candidates if not nominated, I will not accept the nomination or endorsement of any political party other than the one named 1 have been a member of said political party, subject to the exceptions stated in ORS 249.046, for at least 180 days before the deadline for filing a nominating petition or declaration of candidacy (ORS 249.031). Does not apply to candidates filing for the office of US President. Warning A Supplying 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 or not more than one precinct committee person at the same election. Unless the person has withdrawn from the first filing, all filings are invalid.(ORS 249.013 and ORS 249.170) sq Candidate's Signature 11, l 't01 Date Signed Office Use Only: Initials Batch Sheet/CC Approval Code/Receipt bl\A 1 gY~ 2016 CERTIFICATE FOR VOLUNTARY CONTRIBUTION & SPENDING LIMITS CITY OF ASHLAND AMC 2.41 PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK General Election November 8, 2016 Candidate or Political Committee Name Email address Treasurer's Full Name Telephone Number (day) Address (street or route, city, state, zip code) Office of Filing ` I certify that if I am signing a candidate, I will not make attributable expenditures for this election in excess of $3,581.00 (including expenditures of my principal campaign committee), or, if I am signing as a treasurer of a political committee organized exclusively to support or to oppose a candidate, I certify that the committee will not ma a attributable expend' ures in this election in excess of $3,581.00. Candidate or treasurer's ' nature Date Signed [NOTE: If the candidate or committee treasurer elects NOT to be bound by the expenditure limitations, the following line should be signed instead of the line above.] I elect not to be limited to the attributable expenditures specified in this certificate and city ordinance. Candidate or treasurer's signature Date Signed (Authorized Use) The City Recorder is authorized to publish a statement in the City, indicating whether or not the candidate has agreed to Ii expenditures. If the City Recorder or the City Attorney finds that a candidate filing a declaration of limitation on expenditures has exce the applicable expenditure limit, at the next election at which the candidate is a candidate for election to public office, th ty Recorder shall publish a statement, in the City, indicating that the candidate violated a previous declaration of limitationp N CITY OF ASHLAND June 14, 2016 Theo White 1130 Oak Street Ashland OR 97520 A prospective petition has been completed and filed with the City Recorder's Office for Council Position #3. Petition ID CC32016-02 has been approved for circulation to obtain the required 25 signatures for this position. Deadline to submit petitions to the Election Officer is August 12, 2016. Barbara Christensen City Recorder CITY RECORDERITREASURER Tel: 541 X88 5307 W 20 E Main Street Fax: 541.552-2059 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.ows Candidate Signature Sheet I Nonpartisan Petition ID 6C3aa Signatures for this petition are being gathered by ❑PAID Circulators VOLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. 4 Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County S Candidate Information Name `,i( i Office D~~Jc+ Election 6&kqcr~ /10 V District or Position Number NA&j P~ 43 To the Secretary of State of Oregon/County Elections Official/City Recorder, We the undersigned voters, request the candidate'snama be placed on the ballot at the election listed above for nomination to the office indicated. a Signers must initial any changes the circulator makes to their printed name, residence address or date they signed the petition. Signature Date Signed mm/dd/yy Print Name Residence or Mailing Address street, city, zip code 4~ -1AA o . 1 rJ 2 3 4 5 6 7 8 9 10 Circulator Certification This certification must be completed by the circulator and additional signatures should not be collected on this sheet once the certification has been signed and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheet, and I believe each person is a voter qualified to sign the petition (ORS 249.061). 1 also hereby certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. / Circulator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by group submitting the petition. Printed Name of Circulator Circulator's Address street, city, zip code SEL 121 rev 01/14 ORS 249.072 County Elections Officials provide a separate certification to attach to the petition. CITY OF -ASHLAND July 26, 2016 Theo White 1130 Oak Street Ashland OR 97520 The petitions sheets submitted to my office on July22, 2016 have been properly certified by the county elections office. The number of signatures approved were 24. Because the City of Ashland requires 25 approved signatures your petitions is still considered a "Prospective Petition." I have enclosed an additional petition sheet should you decide to continue gathering signatures for candidacy. The deadline for submitting signatures to my office is 3 p.m. on Friday August 12. Please let me know if I can be of any further assistance during this upcoming election time. i Barbara Christensen City Recorder/Treasurer CITY RECORDERITREASURER Tel: 541488-5307 20 E Main Street Fax: 541552-2059 Ashland, Oregon 97520 TTY: 800-735-2900 I_ www.ashland.onus Candidate Signature Sheet I Nonpartisan Petition ID QI [p - 6Z Signatures for this petition are being gathered by ❑PAID Circulators VOLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. O Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. ,.C_ „ Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County Gt, KSV J Candidate Information Name Office J YeD W IVnW7tf Election District or Position N tuber AO (v To the Secretary of State of Oregon/County Elections Official/City Recorder, We the undersigned voters, request the candidate's name be placed on the ballot at the election listed above for nomination to the office indicated. a Signers must initial any changes the circulator makes to their printed name, residence address or date they signed the petition. Signature Date Signed mm/dd/yy Print Name Residence or Mailing Address street, city, zip code 1 2 3 4 5 6 7 8 9 10 Circulator Certification This certification must be completed by the circulator and additional signatures should not be collected on this sheet once the certification has been signed and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheet, and I believe each person is a voter qualified to sign the petition (ORS 249.061). 1 also hereby certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. tls- Circulator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by group submitting the petition. Printed Name of Circulator Circulator's Address street, city, zip code SEL 121 rev 01/14 ORS 249.072 County Elections Officials provide a separate certification to attach to the petition. Jackson County, Oregon COUNTY CLERK COUNTY CLERK Christine Walker (541) 774-61 6147 ELECTIONS (541) 774-6148 July 26, 2016 Barbara Christensen City of Ashland Re: Petition: AshCouncil#3-12, Theo White, Ashland Council #3 Dear Ms. Christensen, We have completed the signature verification for the above named petition. I hereby certify that the above named petition contains no less than 24 signatures of active registered voters in the City of Ashland. /A~ Art C. Harvey, C.E.A. Date Elections Progr Manager Jackson County Fax (541) 7746140 Elections 1101 W. Main St., Suite 201 Medford, Oregon 97501 County: JACKSON Date : 7/26/2016 8:48:32 AM User Name : Harvey, Art C Petition Signers Report Number :AshCouncil#3-12 Title :Theo White, Ashland Council #3 COUNTY : JACKSON SUBMITTAL :Submittal 1 SAMPLE Page Line Voter Id Name Current Residence Current Precinct Status Verification Reason 1 1 18208620 WHITE, THEODORE IAN 1130 OAK ST 004 Accepted Valid Signature 1 2 18118797 GLOVER, DENNIS A 773 SYLVIA ST 004 Accepted Valid Signature 1 3 18147771 OEHLER, ELIZABETH A 215 E NEVADA ST 004 Accepted Valid Signature 1 4 100419348 AUBERT, JACQUELINE R 3 HILLCREST ST 002 Accepted Valid Signature 1 5 Rejected Not Registered 1 6 18118798 CARVALHO, ROSEMARY 773 SYLVIA ST 004 Accepted Valid Signature 1 7 18096980 STRAUB, KELLY N 463 B ST 004 Accepted Valid Signature 1 8 18139392 REYNOLDS, BETTY J 505 HELMAN ST 004 Accepted Valid Signature 1 9 18161697 HEUERTZ, SHALON NICOLE 111 ALMEDA DR 004 Accepted Valid Signature 1 10 18211828 JENSEN,MICHELLE 11301 CORP RANCH RD 018 Rejected Out of District 2 1 300328331 SCHWARTZ 260 N 1ST ST 004 Rejected Signatures Do Not Match VOLTMER,AMANDA LYNN 2 2 100264355 GAMBLE,JULIE ITO 4492 OLD HWY 99 S 018 Rejected Out of District 2 3 18211019 BROOKS, JENNIFER MARIE 161 ALDER LN 004 Accepted Valid Signature 2 4 17149514 SAMPSON, ALISSA LANA 1150 OAK ST 004 Accepted Valid Signature 2 5 18188393 TAYLOR, CARL R JR 945 CEDAR WAY 002 Accepted Valid Signature 2 6 100454706 CLEMANS, ALICE JANE 2963 CHAPMAN LN 013 Accepted Valid Signature 2 7 200126535 WHITE, DEJA RAE 1130 OAK ST 004 Accepted Valid Signature 2 8 18123767 NOYES, DARCY R 384 CAMBRIDGE ST 004 Accepted Valid Signature 2 9 100597288 KOHL, JASON LI 333 N MAIN ST 002 Accepted Valid Signature 2 10 300208444 HARDING, EMMA J 284 W HERSEY ST 10 004 Accepted Valid Signature 3 1 100396192 TACY, STEPHEN LANE 182 4TH ST 004 Accepted Valid Signature 3 2 18156348 CHRISTENSEN, NOELLE 1144 AUGUSTA CT 013 Accepted Valid Signature THERESE 3 3 17338328 LAWSON, BARBARA ELAINE 800 HARMONY LN 007 Accepted Valid Signature Oregon Centralized Voter Registration Page : 1 County: JACKSON Date : 7/26/2016 8:48:32 AM User Name : Harvey, Art C Petition Signers Report Number :AshCouncil#3-12 Title :Theo White, Ashland Council #3 COUNTY : JACKSON SUBMITTAL :.Submittal 1 SAMPLE o-l Page Line Voter Id Name Current Residence Current Precinct Status Verification Reason 3 4 300077932 SKAI, JULIA SIRA 215 HARRISON ST 002 Accepted Valid Signature 3 5 Rejected Not Registered 3 6 18167637 DAMON-TOLLENAERE,MARY 235 5TH ST 004 Rejected Signatures Do Not Match JENNIFER 3 7 18202131 BARBER,JOHN RICHARD 990 BUTLER CREEK RD 018 Rejected Out of District 3 8 100310447 RESCH,JORDAN FRANCIS 1402 TALENT AVE 082 Rejected Out of District 3 9 100268281 WESTERBERG,STEFFAN 2262 ABBOTT AVE 013 Rejected Signatures Do Not Match JAMES 3 10 Rejected Not Registered 4 1 Rejected Not Registered 4 2 100245045 DERRIG, MICHAEL JAMES 1768 CRESTVIEW DR 013 Accepted Valid Signature 4 3 300152190 DWYER, MARK PATRICK 773 OAK ST 004 Accepted Valid Signature 4 4 100319927 KYLE, ANTHONY L 1550 OREGON ST 10 007 Accepted Valid Signature 4 5 11511183 MARKS, NEENA MARIE 36 S 2ND ST 1 002 Accepted Valid Signature Oregon Centralized Voter Registration Page : 2 County: JACKSON Date : 7/26/2016 8:48:32 AM User Name : Harvey, Art C Petition Signers Report Number :AshCouncil#3-12 Title :Theo White, Ashland Council #3 Summary Results For Petition AshCouncil# Petition Title Theo White, Ashland Council #3 Circulation Start Date : 06/14/2016 Circulation End Date 07/25/2016 Signature Count Required 25 ACCEPTED 24 REJECTED 11 Total 35 Page : 3 Oregon Centralized Voter Registration Candidate Signature Sheet I Nonpartisan Petition ID 6C3aa Signatures for this petition are being gathered by ❑PAID Circulators &VOLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. (1)Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. County S (r Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. Candidate Information Name Office -{y-~ _ n Pa's Election N O V D District or Position Number ~ni'(, To the Secretary of State of Oregon/County Elections Official/City Recorder, We the undersigned voters, request the candidate's name be placed on the ballot at the election listed above for nomination to the office indicated. a Signers must initial any changes the circulator makes to their printed name, residence address or date they signed the petition. Signature Date Signed mm/dd/yy Print Name \ - RResidence or Mailing Address street, city, zip /code 2 XJ -7'7 ~7520 a Q y 1 , C 3 4 ~ 3 ~ C ~ `~-e ( e✓~ ~S~T J~ 5 1 © La Ql r) S v /~r la d P CIA- 7 JIIWI 8 e ✓ ,115 9 U nn io 4a to J C)r cif. WIV Circula or Certificatio is certification must be completed by the circulator and additional signatures should not be collected on this sheet once the certification has been sig and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheet, and I believe each person is a voter qualified to sign the petiti (ORS 249.061). 1 als hereby certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. / Circulator Signature Date Sig ed mm/dd/yy Sheet Number Sheet will be numbered by group submitting the -7 ' petition. Printed ame of Circulator Circulator's Address street, city, zip code SEL 121 rev oi/14 oas 249.072 County Elections Officials provide a separate certification to attach to the petition. Candidate Signature Sheet I Nonpartisan Petition lD CC3aoI Signatures for this petition are being gathered by ❑PAID Circulators VOLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. - Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County Candidate Information Name L Office DAZ40 qA~w e a In:c~ Election District or Position Number C ,rWj\i /lI/t1~1 To the Secretary of State of Oregon/County Elections Official/City Recorder, We the undersigned voters, request the candidate's name be placed on the ballot at the election listed above for nomination to the office indicated. a Signers must initial any changes the circulator makes to their printed name, residence address or date they signed the petition. ~ture !Sign d mm/dd/yy Print Name Residence or Mailing Address st eet, city, zip code Y ~~o ~ ~Il~ t~ &AAq r 1 i> 1 4 (9 5 I S S~ D 11 J/ C2 S 4P 6 J tot; e i 8 1 '7 -l '7 9 Y ~r ✓ l 10 a7 ~ Circa ator Certification This certification must be completed by the circulator and additional signatures shou not be collected on this sheet once the c ification has been signed and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheet, and I believe each person is a voter qualified to sign the petition (ORS 249.061). I also ereby certify that compensation I received, if any, was not ased on the numb of signatures obtained for this petition. Circulator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by group submitting the petition. Printed Name of Circulator Circulator's Address street, city, zip code SEL 121 rev 01/14 ORS 249.072 County Elections officials provide a separate certification to attach to the pe Candidate Signature Sheet I Nonpartisan PetitionlD GC3ao~~- Signatures for this petition are being gathered by ❑PAID Circulators &VOLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. O Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. C Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County 3 Candidate Information Name Office lea 7qA~6~ Election Nov E, A011,0 I District or Position Number Pas * 3 To the Secretary of State of Oregon/County Elections Official/City Recorder, We the undersigned voters, request the candidate's name be placed on the ballot at the election listed above for nomination to the office indicated. a Signers must initial any changes the circulator makes to their printed name, residence address or date they signed the petition. Signature Date Signed mm/dd/yy Print Name Residence or Mailing Address street, city, zip code 1 71 01 TEPtABN L . Ac 1 ?-12 T r - Ns bR 9-1520 1. 1 y +w c - U 0.ne( a2 752 o 2~ z~c a~IIL s 3 oo JA Ck r o 14n., a 4 2l~ t V«on d~5t~(~~ 47~za 6 L-7- VLIIu q (F6 9 ~G t.JCS ~G~r~e - 5 c In 22 ~Z CA v 10 C~~n ~C4*"~ ~s 5b fi Circulate ertification This certification must be completed by the circulator and additions natur hou not be collected on this sheet once the certification has been signed and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheet, and I believe each person is a voter qualified to sign the petition (ORS 249.061). J1 als` hereby certify that compensation I received, if any, was not based o the number o signatures obtained for this petition. Ci Date Signed mm/dd/yy Sheet Number rculator Signature Sheet will be numbered by group submitting the petition. Printed Name of Circulator Circulator's Address street, city, zip code SEL 121 rev 01/14 ORS 249.072 County Elections Officials provide a separate certification to attach to the petition. Candidate Signature Sheet I Nonpartisan Petition ID 60 Adl Signatures for this petition are being gathered by ❑PAID Circulators &VOLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County Candidate Information Name e Z) , Vv I _ Office 4 Election District or Position Number To the Secretary of State of Oregon/County Elections Official/City Recorder, We the undersigned voters, request the candidate's lname be pllaacceed1 on the ballot at the election listed above for nomination to the office indicated. a Signers must initial any changes the circulator makes to their printed name, residence address or date they signed the petition. Sign ture Date Signed mm/dd/yy Print Name Residence or Mailing Address street, city, zip code 1 Q e,~I Kp C 13 3 C? Z A c "I 5d~ zo ~Co I-Q 3 2 fl a6 l~ G ~ISJ 4 ll`~ _~LJ U / V~l 1 'f~ M YY 5 6 7 8 9 10 Circulator Certification This certification must be completed by the circulator and additional signatures should not be collected on this sheet once the certification has been signed and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheet, and I believe each person is a voter qualified to sign the petitio ORS 249.061).rl also hereby certify that compensation I received, if any, was no based on the number of signatures obtained for this petition. l~I Circu for Signature Date igned mm/dd/yy Shee Number / Sheet will be numbered by J(~ group submitting the petition. Print d Na a of Circulator Circulator's Address street, city, zip code SEL 121 rev 01/14 oas 249.072 County Elections officials provide a separate certification to attach to the petition. Petition Submission SEL 338 rev 01/14 Candidate, Voters' Pamphlet OAR 165-010-0005,155-014-0005 This form must be completed and filed with each submittal of signatures. Filing officer FE -]State County for both county and district petitions kc-city Election Type Year ] Primary FUC eneral [l Special Election 2014 M 2016 2018 Petition Information Candidate Name r Measure Nymbe~. IWI 1 - Type of Filing Number of Signatures Submitted Candidate Nominating Petition ❑ Voters' Pamphlet, Candidate ❑ Voters' Pamphlet, Measure Candidate By signing this document, I hereby state that all information on the form is true and correct to the best of my knowledge. Na a Contact Phone Email Address 5c~~) ~S~-ZbCN~ A-(,j J-t~ JAC Signature Date igned / LfE" Measure Argument Filer By signing this document, I hereby state that all information on the form is true and correct to the best of my knowledge. Name Contact Phone Email Address Signature Date Signed tv'F'z `/ut q e "o , Y. 2416 CITY OF ASHLAND August 3, 2016 Theo White 1130 Oak Street Ashland OR 97520 A completed petition, with the required signature sheets properly certified by the county elections office has been received and is filed with the City Recorder's Office for City of Ashland Councilor Position #3. Please let me know if I can be of any further assistance during this upcoming election time. Barbara Christensen City Recorder/Treasurer CITY RECORDERITREASURER Tel: 541488-5307 20 E Main Street Fax: 541-552-2059 Ashland, Oregon 97520 TTY: 800 735 2900 I_ www.ashland.orms Candidate Signature Sheet I Nonpartisan Petition ID ~iJo?01 itO - ~,2 Signatures for this petition are being gathered by ❑PAID Circulators VOLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. O Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County G(,(~ Candidate Information Name Office W ►VdW7~f +iC,~ Y.J Election District or Position N Amber (IN lwzl h I~ O To the Secretary of State of Oregon/County Elections Official/City Recorder, We the undersigned voters, request the candidate's name be placed on the ballot at the election listed above for nomination to the office indicated. A Signers must initial any changes the circulator makes to their printed name, residence address or date they signed the petition. Signature Date Signed mm/dd/yy Print Flame Residence or Mailing Address street, city, zip code 1 07- 12-V 1!G , n ~°S 9 ~ ~t ~sc~ 1-5-If 4--4 2 3 4 5 6 7 8 9 10 Circulator Certification This certification must be completed by the circulator and additional signatures should not be collected on this sheet once the certification has been signed and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears on the signature sheet, and I believe each person is a voter qualified to sign the petitio (ORS 249.061). 1 also hereb certify that compensation I received, if any, was not b sed cn th number of signatures obtained for this petition. Circu for Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by `v [group submitting the G petition. Printed Name of Circulator Circulator's Address street, city, zip code SEL 121 rev 01/14 ORS 249.072 County Elections Officials provide a separate certification to attach to the petition. Jackson County,' Oregon COUNTY CLERK COUNTY CLERK Christine D. Walker (541) 774-6147 ELECTIONS (541) 774-6148 August 3, 2016 Barbara Christensen City of Ashland Re: Petition: AshCouncil#3-12, Theo White, Ashland Council #3 Dear Ms. Christensen, We have completed the signature verification for the above named petition. I hereby certify that the above named petition contains no less than 25 signatures of active registered voters in the City of Ashland. A4l r~II Art C. Harvey, C.E.A. Date Elections Program M ager Jackson County Fax (541) 774-6140 Elections 1101 W. Main St., Suite 201 Medford, Oregon 97501 0 W W W N N N N N N N N N N F- N F- I 0! 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N O 7 3 3 n cn (D 3 O > rcur 04 r C Z rD CL C (D N °~n (DD rw+ rD v _0 Q 3 to c r7 CD c o O -s O Qj lD v) rD rD (D rt O rD( (D Q CIL) O O ::3 D o C7 - Ln C rD Lrl (D Ln (A / FD' CD < CD r) rD rr CD n Q (rf CD O CD O r) C) v O O rD yl rt C ID rD (D fu r Ln P1 r+ O lD ~ 3 •G < v CL -41 O N (D ID rt N (D I S ~ ` n \ (D 0- (D 0 O D N ~ Vf r( S D _ Q N -0 N c t~' rr - n C S ry _ O r' . ~ Q Cr (D 3 z LI) Ln cu o h 0- 0 r 3 3 O O (D a rt < O rD `D cD rD Q 1 (D rD o r~ sz Petition Submission ,F-L.JaU Candidate, Voters' Pamphlet OAR 165-010-0005, 165-rev 01/14 014-0005 This form must be completed and filed with, each submittal of signatures. Filing Officer 171 State County for both county and district petitions City Election Type Year Primary I_U eneral ~i Special Election Imo. 2014 ED 2016 2018 111 Petition Information Candidate Nam e r Measure NYmt b~ l W ~r ~w -Theo Type of Filing Number of Signatures Submitted Candidate Nominating Petition ❑ Voters' Pamphlet, Candidate ❑ Voters' Pamphlet, Measure Candidate By signing this document, I hereby state that all information on the form is true and correct to the best of my knowledge. Na a Contact Phone Email Address Liv-v I S no C~ ` t,` 4L-~-Z- A - i Signature t~ Date igned Measure Argument Filer 4 By signing this document, I hereby state that all information on the form is true and correct to the best of my knowledge. Name Contact Phone Email Address Signature Date Signed 1 LLJ /14 C\j CD., <4 _4,yyw♦ UJ C..) C c SO w1 J