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HomeMy WebLinkAboutBiome Erickson Completed Candidate Filing SEL 101 Major'Political Pa+'ty or Nonpartisan rev 09/15 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 0 All information must be completed or the form will be rejected. This filing is an CK Original ❑ Amendment Filing Officer ❑ Secretary of State ❑ County Elections Official City Recorder (Auditor) Office Information Filing for Office of: A-Ailay~A District, Position or County: u !I a r Party Affiliation: ❑ Democratic Pa ❑ Republican Party ❑ Independent Party onpartisan Incumbent Judge: ❑ Yes ❑ No 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 5(No Candidate Information Name of Candidate First MI Last Suffix Title K M Sri Gks o n How you would like your name to appear on the ballot IOM M C C-rl t r l /c- r Candidate Residence/Route Address Street Address City State Zip County ?wog H4"' aG+±r,icS~'~-j s1~~QVIa< D/Z 9Is-2v 7qS~/~/ Candidate Mailing Address Street Address or PO Box City State Zip Sq~ s~ JUN 2 2 2016 Continued on the reversed side of this form L. Y: ----4/------ Contact Information: Only one phone number is required. Work Phone Home Phone Cell Phone Fax Sill--4Lj I -2sg~j Email Address Web Site, if applicable ratu~IO-Y)%- M ` Occupation (present employment) If no relevant experience, None or NA must be entered. IV14 Occupational Background (previous employment) If no relevant experience, None or NA must be entered. y1 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 Background (other) Attach a separate sheet if necessary. Prior Governmental Experience elected or appointed) If no relevant experience, None or NA must be entered. /V/4 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). By signing this document, l hereby state that: I 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 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 re than one precinct committee person at the same election. Unless the person has withdrawn from the first flin II fi in RS 249.013 and ORS 249.170) ✓UN zo16 0h l z~ 1, e. Candi e's Signature Date Signed Office Use Only: Initials Batch Sheet/CC Approval Code/Receipt Number 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 I o NxR K ~ccA-* i10rvv M124 Treasurer's Full Name Telephone Number (day yt- Z Address (street or route, city, state, zip code) 20(6 Y, 4(q A,61a4tz Office of Filing Or 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. di a 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 The City Recorder is authorized to publish a statement in the City, indicating whether or not the candidate has agreed to limit (Authorized Use) ~~y~~ expenditures. D VV If the City Recorder or the City Attorney finds that a candidate filing a declaration of limitation on expenditures has exceeded JUN 2 2 2016 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. B Y; -_--1 CITY OF ASHLAND June 22, 2016 Keith M. Erickson 208 Hargadine Street #4 Ashland OR 97520 A prospective petition has been completed and filed with the City Recorder's Office for Mayor. Petition ID M2016-03 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. Dana Smith Assistant to the City Recorder CITY RECORDEWREASURER 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 (Y~ aol(P 'y3 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. i Signatures must be verified by the appropriate county elections official before the petition can be filed with the filing officer. y' Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County Candidate Information Name ~ ~ dM e.. (V1c ~,~G~2, I ~ ri c,kso~n Office (1n. ~`~l Q r Election District or Position Number en.~r~,l c,.~ ~uv Rollo a.Ollo Cx- 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 06 LZ 1/ /4 9e16 S~ 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). I also hereby certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. (OD 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 -AS H LAN D August 3, 2016 Biome Michael Erickson 208 Hargadine Street #4 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 Mayor. Please let me know if I can be of any further assistance during this upcoming election time. Barbara Christensen City Recorder/Treasurer CITY RECORDEWREASURER Tel: 541488-5307 20 E Main Street Fax: 541552-2059 FW Ashland, Oregon 97520 TTY: 800-735-2900 1JAN www.ashland.orms Jackson County, Oregon COUNTY CLERK MIZ K Christine Walker (541) 774-61 6147 COUNTY CLER ELECTIONS (541) 774-6148 July 27, 2016 Barbara Christensen City of Ashland Re: Petition: AshMayor4, Biome Michael Erickson, Ashland Mayor 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 26 signatures of active registered voters in the City of Ashland. Art C. Harvey, C.E.A. Date Elections Program ager Jackson County Fax (541) 774-6140 Elections 1101 W. Main St., Suite 201 Medford, Oregon 97501 CITY OF ASHLAND July 18, 2016 Biome Michael Erickson 208 Hargadine Street #4 Ashland OR 97520 The petitions sheets submitted to my office on June 22, 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. Barbara Christensen City Recorder/Treasurer CITY RECORDERIiREASURER Tel: 5411188-5307 20 E Main Street Fax: 541552-2059 W Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.orms Jackson County, Oregon COUNTY CLERK COUNTY CLERK Christine D. Walker (541) 774-6147 ELECTIONS (541) 774-6148 July 15, 2016 Barbara Christensen City of Ashland Re: Petition: AshMayor4, Biome Michael Erickson, Ashland Mayor 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. Art C. Harvey, C.E.A. Date Elections Program anager Jackson County Fax (541) 774-6140 Elections 1101 W. Main St., Suite 201 Medford, Oregon 97501 Petition Submission SEL 338 OAR 165-010-0005, 165-014-0005 ,Candidate, Voters' Pamphlet -ev 0114 This form must be completed and filed with each submittal of signatures. Filing Officer ri State County for both county and district petitions City Election Type Year Primary General ❑ Special Election 2014 _ 2016 Fp- 2018 Petition Information Candidate Name or Measure Number Type of Filing Number of Signatures Submitted andidate 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. Name Contact Phone Email Address Ke~~ M Fr, Signat a Date Signed Cq 2- i 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 O Petition Submission SEL 338 rev 01/14 .Can6date, Voters' Pamphlet OAR 165-010-0005,165-014-0005 This form must be completed and filed with each submittal of signatures. Filing Officer . r~ State Fo County for both county and district petitions City ~j Election Type Year Primary General ❑ Special Election 2014 2016 10 2018 Petition Information Candidate Name or Measure Number M Type of Filing Number of Signatures Submitted Candidate Nominating Petition ❑ Voters' Pamphlet, Candidate ❑ Voters' Pamphlet, Measure Candidate 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 PX M 1-rc G1k9~ Sy~`9cl(-Z5 5 ~ CJI - r►~2i/ Signat a Date Signed ©3IZfi Measure Argument Filer F4 -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 County: JACKSON Date : 7/27/2016 11:13:05 AM User Name : Harvey, Art C Petition Signers Report Number :AshMayor4 Title :Biome Michael Erickson, Ashland Mayor Summary Results For Petition AshMayor4 Petition Title Biome Michael Erickson, Ashland Mayor Circulation Start Date : 06/22/2016 Circulation End Date 07/12/2016 Signature Count Required 25 ACCEPTED 26 REJECTED 10 Total 36 Oregon Centralized Voter Registration Page : 3 County: JACKSON Date : 7/27/2016 11:13:05 AM User Name : Harvey, Art C Petition Signers Report Number :AshMayor4 Title :Biome Michael Erickson, Ashland Mayor COUNTY : JACKSON SUBMITTAL : Submittal 1 SAMPLE Page Line Voter Id Name Current Residence Current Precinct Status Verification Reason 1 1 100465950 ERICKSON, KEITH M 208 HARGADINE ST 4 002 Accepted Valid Signature 1 2 100307746 WOJT, RYAN MATTHEW 1040 PLAZA AVE 013 Accepted Valid Signature 1 3 18181706 FRANCIS, WILLIAM J 40 VAN NESS AVE B 004 Accepted Valid Signature 1 4 18161052 DOLINGER, RANDY LEE 596 PARK ST 2 013 Accepted Valid Signature 1 5 100166566 PRICHARD, GALEN MICHAEL 925 GLENDOWER ST 004 Accepted Valid Signature 1 6 Rejected Not Registered 1 7 Rejected Not Registered 1 8 18208990 CARSON, MARJORIE LARSON 455 B ST 004 Accepted Valid Signature 1 9 300394853 PALMER,GRETCHEN 184 B ST 004 Rejected Signatures Do Not Match VIRGINIA 1 10 18096135 MEYER-ROOKLYN, KIMBERLY 137 7TH ST 004 Accepted Valid Signature 2 2 18160849 CRANE, NICHOLAS T 282 JOSEPH DR 082 Accepted Valid Signature 2 3 300298701 PERL, ORLY 180 HARRISON ST 002 Accepted Valid Signature 2 4 18138760 VERNER, DANIEL LEE 297 6TH ST 004 Accepted Valid Signature 2 5 18225492 DUVAL, MELISSA GALE 830 ASHLAND ST 007 Accepted Valid Signature 2 6 100377781 MCNULTY,PATRICK W 375 E MAIN ST 004 Rejected Inactive Other or Reason Not Known 2 7 100458708 BURKHARDT,KATE ELISE 885 CLAY ST 121 013 Rejected Signatures Do Not Match 2 8 Rejected Not Registered 2 9 18097635 GRAY, DENNIS J 27 W HERSEY ST 004 Accepted Valid Signature 2 10 18154994 NEWMAN, BRUCE J 1310 ROMEO DR 007 Accepted Valid Signature 3 2 18219351 CHASE, JOSEPH A 252 7TH ST 004 Accepted Valid Signature 3 3 300420641 BALDWIN,BART 725 S VALLEY VIEW RD 018 Rejected Out of District 3 4 100307339 PICTON, MATTHEW 220 STRAWBERRY LN 002 Accepted Valid Signature CHRISTOPHER Oregon Centralized Voter Registration Page : 1 County: JACKSON Date : 7/27/2016 11:13:05 AM User Name : Harvey, Art C Petition Signers Report Number :AshMayor4 Title :Biome Michael Erickson, Ashland Mayor COUNTY • JACKSON SUBMITTAL : Submittal 1 v SAMbLF Page Line Voter Id Name Current Residence Current Precinct Status Verification Reason 3 5 18161449 FORBES, LORNA 1031 IVY LN 007 Accepted Valid Signature 3 6 Rejected Not Registered 3 7 100507038 JONES, ANDREW LINSLEY 325 SHERIDAN ST 002 Accepted Valid Signature 3 8 300328077 VILLA, SY ALEXANDRIA 1354 QUINCY ST it 007 Accepted Valid Signature 3 9 18131336 PEPE, ALBERT L 321 CLAY ST 21 013 Accepted Valid Signature 3 10 100325156 WILSON,DEBRA JOY 108 CROCKER ST 013 Rejected Signatures Do Not Match 4 2 10624726 REIF, RAEL BETH 611 SHERWOOD AVE 013 Accepted Valid Signature 4 3 300439583 ROARK,ROBERT R 325 MOBILE DR 018 Rejected Out of District 4 4 300389852 BOWMAN, TYLER JONATHON 468 B ST 8 004 Accepted Valid Signature 4 5 18205063 HOLT, JASON ROBERT 921 MARY JANE AVE 013 Accepted Valid Signature 4 6 200091005 LITTLE, RONALD WALLACE 180 LOGAN DR 002 Accepted Valid Signature 4 7 100559423 RA, CAROLINE 1390 OREGON ST 007 Accepted Valid Signature SUBMITTAL : Submittal 2 SAMPLE Page Line Voter Id Name Current Residence Current Precinct Status Verification Reason 1 2 18097346 HILL, MADELINE 828 BOULDER CREEK LN 004 Accepted Valid Signature 1 4 300270716 LAIDLAW, ZOE FINCH 347 LANTERN HILL DR 002 Accepted Valid Signature Oregon Centralized Voter Registration Page : 2 County: JACKSON Petition Processing Statistics Report Date : 7/15/2016 12:59:25 PM User Name : Harvey,'Art C Number :AshMayor4 Title :Biome Michael Erickson, Ashland Mayor Petition Information Petition Name : Biome Michael Erickson, Ashland Mayor Petition Date : 06/22/2016 Date Filed : 06/22/2016 End Circulation Date : 07/12/2016 Minimum Signatures Required : 25 Accepted Of Minimum: ( 96.00% ) Total Signatures Processed : 34 Processing Summary Sample: All Total Accepted Signatures : 24 (71%) Of Those Processed Total Rejected Signatures 10 (29%) Of Those Processed Accepted Reason Total Rejected) Valid Signature 24 (1000/0) Rejected Reason Total. Rejected) Not Registered 4 (40%) Out of District 2 (20%) Signatures Do Not Match 3 (30%) Inactive Other or Reason Not Known 1 (10%) Oregon Centralized Voter Registration Page : 1 Candidate Signature Sheet I Nonpartisan Petition ID rn aol(P "y3 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 7C.61LS Candidate Information Name S 1 i ors e, Office or Election District or Position Number ao►~ Gi;~„~,iro,,l nvv a.o►lo 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 22 2 Ta- (al al I I (P k,,IA A A \J O't / 2- ;L , V'7'^4~ 'S"n =A~N~ S L J 6/7- Z A/6 l2a" T-)o Z avL.k S 4 r ' 5 (~~r 6 3 QL-'k a 2,1 12 t C~ t -1 8 9 10 oil Circulator Certication This certification must be complete y the circulator and additional signatur s shou 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. i2 b 4, 1 irculator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by ~ group submitting the IA , , i ~YV 91 _ pe Lf 4-96 ",Z Printed Name of Circulator Circula is 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 nrl a.oys -03 Signatures for this petition are being gathered by ❑PAID Circulators QVOLUNTEER 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 Spm on the filing deadline day. County ~t3•C.kS !1~ Candidate Information Name 1 Office i 00, C Mt C'Ino..P- r; t ~ , or Gi Election District or Position Number aOllo ~-ern.t,ral R-c+;tw-~ nov F, ~ollc 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 -27 52521? 3 4 4 V- I/ ~F Ue>A ('5-sA -Dilwaf 6 /-sAo w L CAA7r~A)- &77eW C/ Ili 8 ei C ~(q VL,~515 0 10 04 ) 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. Z Circulator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by group submitting the rt L/I~-5tJUY1 9 petition. Printed Name of Circulator Circulate 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 on a0114 -y3 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. `:J 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 7cc -C -s p,rn Candidate Information Name 1 Office i orn e. Mc c,1-Io-e, r; l , (,k.s`on r OF t9 51) Election District or Position Number a Otto G~-e.,ntxc#-I ~l L+;c,•~ nvv xollo 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 0=1 40WQ~" 14 E" Z 4~ ~0311~ J ose~12 252 S6r~t S gz: 4~3 F'1 ~t V ck-j V, 2-7 0 S✓ 7 kAAII 0r2 9 j~> 3'2-\ C ct c,4 (3 Circulator Certification This certification must be competed y 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 249.0061).-1 also hereby certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. . L i C(rculator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by r^ o A group submitting the 70G/ r/' t t ~ 5 4 petition. Printed Name of Circulator Circula '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 ryl aolu 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 0y-, Candidate Information Name Office r3 i orY, e~ Mt E r; c,ks~o~n (1n or C i o F q s 1~ l~.d Election District or Position Number c~.Ollo GC•e~-tral ~L+;c,~ f~oU F, ?,Otto 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 I (p ~ 6 ~w~-o r vrri o (O ,-ei ti 4 7 e J a av. ~\C\~ o,1. s 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. . C culator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by r group submitting the 5 f . i/ I ' En 5 y ii~A c .b / petition. Printed Name of Circulator Circulator'sti4ddress 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 ( Nonpartisan Petition lD M a0~~ •63 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. y 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 0y-% Candidate information Name Q i ofy% Q„ Mt 61no ri L~SdYI Office ^A or Election District or Position Number a011o Grt-n coal c,+ *c,n nov i, xm, 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 we 2 g,G~n All 3 f e2g2ilm IL 71 9 4 2~j 'A Z La - 1 k! ~0 / 5 ~Zc ZU sti S~ 6 78-5 0 Z v// S 7 S/s 1( P j U PJ. 2, -ii q M o Q 72 N, sk1Q A CJ~~ ►'\.0 / r 1 t o2n Circulator Certification This certification must be completed by the circulator and additional signatures should not be collected on this sheet once a 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 comp nsation I ceived, if, any, was not based on Jail" the number of signatures obtained for this petition. 25 lv (9 Irculator Signature D e Ac II FdW- Sheet Number Sheet will be numbered by ~n~C G ( i~ c 5f L( group submitting the petition. Printed Name of Circulator Circulator's Ad ess street, city, zip code SEL 121 rev 01/14 ORS 249.072 County Elections Officials provide a separate certification to attach to the petition.