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HomeMy WebLinkAboutMartin Kamenski Candidate Filing SEL v01 rev 09/15 Major 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 ® All information must be completed or the form will be rejected. This filing is an Original ❑ Amendment Filing Officer ❑ Secretary of State ❑ County Elections Official City Recorder (Auditor) Office Information Filing for Office of: District, Position or County: Party Affiliation: ❑ Democratic Party ❑ Republican Party ❑ Independent Party $g Nonpartisan Incumbent Judge: ❑ Yes ❑ No r 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 gj No Candidate Information Name of Candidate First Mt Last Suffix Title 1441w(m M K4A4X-NSK t How you would like your name to appear on the ballot M- rv--rtw KAm&-#.jSt.<1 Candidate Residence/Route Address Street Address city - State Zip County 7g2 L wD- f LN H L ND S~ ~~C~C54111 Candidate Mailing Address Street Address or PO Box City State Zip SAME- Continued on the reversed side of this form Contact Information: Only one phone number is required. Work Phone Home Phone Cell Phone Fax 2-l SS-7- Email Address Web Site, if applicable I ~Vtartil7inUm~.I wIC~. me Occupation (present employment) If no relevant experience, None or NA must be entered. CEO F--J"t To Occupational Background (previous employment) If no relevant experience, None or NA must be entered. C,0mL&9tLY GEb ov- t~vs~►-~ s Co A,0MN4 Corti-~Y Cwtot, L)As ots &vp VP ~ccD~pN-rt+~►c~ ~~A~'ctC~E 3►d C~tC~O 044m, tJAS Cp~SdL~C ?t Arc J Rtctw+!-c~Est}t~ ~6~~5eS 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 A,2 taE't'CE t 7EAS ov O)iweastrz b 5 ~7CCO~AVr 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. S62vo=a ON Saes Oa atR&-e-CoizS kee : !t Am-ccr- IbAl "C,E (oA&F-A&3-•f, Co ~oa~ Lit oB~K- 0_4"4wKr- Op' 42-T1SrS Campaign Finance Information (not applicable to candidates for federal office) Candidate Committee ❑ Yes, I have a candidate committee. ❑ No, 1 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. XNo, but will be filing a Statement of Organization for Candidate Committee (SEL 220). By signing this document, I hereby state that: -a 1 will accept the nomination for the office indicated above I will qualify for said office if elected 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 I 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. A Warning 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, 11 AWLqs are invalid.(ORS 249.013 and ORS 249.170) HII Candidate's Signature fflJ Date Signed Office Use Only: Initials Batch Sheet/CC Approval Code/R5cY1pQI.mbe: 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 ~ wf NS~I Treasurer's Full Name Telephone Number (day) sy~ ssz. ~6oa Address (street or route, city, state, zip code) 14$2 N L,4 t-> 02 `T SZO Office of Filing ClT oVA1GtL I certify that if I am signing as 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 make attributable expenditures in this election in excess of $3,581.00. Candidate or treasurer's signature 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 se) The City Recorder is authorized to publish a statement in the City, indicating whether or not the candidate has agreed to limit /j expenditures. If the City Recorder or the City Attorney finds that a candidate filing a declaration of limitation on expenditures has exceeded the applicable expenditure limit, at the next election at which the candidate is a candidate for election to public office, the City Recorder shall publish a statement, in the City, indicating that the candidate violated a previous declaration of limitation. D CITY OF ASHLAND July 7, 2016 Martin Kamenski 482 Lindsay Lane Ashland OR 97520 A prospective petition has been completed and filed with the City Recorder's Office for City Councilor Position #1. Petition ID CC 12016-02 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: 541.488-5307 20 E Main Street Fax: 541-552-2059 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.orms Candidate Signature Sheet I Nonpartisan Petition ID ' 6 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 jvl~sm Candidate Information Name at Office q~~j _ ('AJ~YI.~ o I - Election Q?01 ~ Q J District or Position Number PC , To the Secretary of State of Oregon/County Elections Official/CC•iitt/y 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-- ~~~~11o M~htt-CtN k~Ar~E~s1~1 ~Z Lr~y05 Lay /~}~t~4~.tD ©Q g ~S~'Lo 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.