HomeMy WebLinkAboutMartin Kamenski - Withdrawal
Candidate Filing SEL 150
Withdrawal rev 1/16 ORS 249.170, ORS 249.180
ORS 249.830, ORS 255.235
Withdrawal Deadlines
2016 Primary Election 2016 General Election 2017 District Election
March 11, 2016 September 2, 2016 March 16, 2017
0 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)
Withdrawal from Candidacy or Nomination for Office Information
Office of: Ct T Go v N C t
District, Position or County: 0051? fl►-D I
❑ Candidacy for Nomination ❑ Nomination to Political Party
Candidate and Nominee Information
Name of Candidate
First MI Last Suffix
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Candidate Residence/Route Address
Street Address City State Zip
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Candidate Mailing Address and Contact Information: Only one phone number and an email are required.
Street Address or PO Box City State Zip
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Work Phone Home Phone Cell Phone Fax
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Email Address (required) Web Site, if applicable
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Withdrawal Reason-
I submit notice of withdrawal from candidacy or nomination to the above named office. My reason for withdrawal is:
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By signing this document, / hereby state that:
I withdraw my candidacy or nomination for the office stated above and
The reasons provided by me on this form for withdrawal are true.
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).
Candidate's Signature Date Signed
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For Office Use Only Initials
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