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HomeMy WebLinkAboutDoug Burns Completed 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 Flied 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 I Filing Officer ❑ Secretary of State ❑ County Elections Official *City Recorder (Auditor) Offlce Information Filing for Office of: of-r'/ CO L District, Position or County: Pp S 1 -1-1 p N Party Affiliation: ❑ Democratic Party ❑ Republican Party ❑ Independent Parry ® Nonpartisan Incumbent Judge: ❑ Yes JA No F- Nondisclosure on file Paying by Declaration or Petition: Eq 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 KProspective Petition Petition circulators will be paid ❑ Yes No Candidate Infonnation Name of Candidate First MI Last R..Aj 5 Suffix Title J> oOG LAS How you would like your name to appear on the ballot Candidate Reeklinu lRoute Address Street Address 'i City State 0,,;? Zip q7,5--~ p Coun k~` _0AJ T 7 C 4 l,.l F6RtJ 1 A 5"r '7 ~ Candidate Mailing Address Street Address or PO Box City State Zip SAft\ir Continued on the reversed side of this form Contact Information: Only one phone number is required. Work Phone Home Phone Cell Phone Fax JIA- NIl* N~ 119-50Q-.5305. Email Address Web Site, if applicable cLaw burns pk0t4la com 1'J Occupation (present employment) If no relevant experience, None or NA must be entered. lemma c-o Occupational Background (previous em to meat If no relevant experience, None o NA must be entered. ~CRAI- V I; cr ffFse4&aTr)A c wLrT~Scb%&iS 6)1 &AR1a*J-R-CasA, N Y, J ~ 06-6 C~97 7-g1 r-/6CqLO!',F[C6 /)r kA SA04USrs e6uvc14- orv-T-XC f}erS)„BciS7c~it,`/I?~4 73) Educational Background (schools attended) If no relevant experience, None or NA must be entered. Complete name of School no acronyms) Last Grade completed Di loma/D ree/Certificate Course of Stud 7-q l WhAI&E rftCiJ i S6pj L )A; t I -r /b C O M /-Au 86 Fco e c_s' c LZ- / -S L / -DIvAj- Q4cC,-, e / '4 1: 2,- W I Educational Background (other) Attach a separate sheet it necessary. Prior Governmental Ex rience elected or appointed) If no relevant experience, None or NA must be entered. Ftsc R4 OFFICk R, 0cMMVA11 ---RL7tf 0, + PrsSf cW& 6c , (~,t/C tL Qitl ~ E r`~,2rS ffNO ~7~4✓v rTiF S rnL'M13Fe, '~NR~vcrrt~~ 72%6 BY G10V1EXJ-A72 6FsMSsRczzfu-SG7-7-S Campaign Finance Information (not applicable to candidates for federal office) Candidate Committee ❑ Yes, I have a candidate committee. to 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, I 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 parry other than the one named I have been a member of said political parry, 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. Wam A Supplying false information on this form may result in conviction of a felony with a line 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) Candidate's S atu 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 Genera( Election November 8, 2016 s, 'date or Political Co mime Name Email address -1-k~osi-AS , 3 LJkN S e bu i rls oars, Cd Trea urer's Full Name Tele ne Number (day) VA Address (street or route, city, state, zip code) Office of Filing 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 t make a bes ble 7exditur in this election in excess of $3,581.00. q /wa/'Qa 16 c Candidate trea er's signature bat; Signed (NOTE: If the candidate or committee treasurer sleM NOT to be bound by the expenditure IlmlMlons, 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 limit 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. CITY OF -AS H LAN D August 10, 2016 Doug Burns 77 California Street $4 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 12016-01 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 RECORDEWREASURER Tel: 541488-5307 20 E Main Street Fax: 541-552-2059 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.orms Candidate Signature Sheet Nonpartisan Petition ID u.•l" Signatures for this petition are being gathered by ❑PAID Circulators J/OLUNTEER 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. ~J Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. County Candidefe inforh4ticn Name D D Lt~ Office rj &1~1 Election 4 District or Position Number 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 b'a1llott at the election_listed above for nomination to the office indicated. 8 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 o UGCaS G.~URN S ~oR L,A ST, ~ ~sil~ 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. Circulator Signature Date Signed mm/dd/yy Sheet Number Sheet Will be-Numbered by group s€ibrhittirtg 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 August 23, 2016 Doug Burns 77 California 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 Councilor Position #l. Please let me know if I can be of any further assistance during this upcoming election time. r XLMX- Barbara Christensen City Recorder/Treasurer CRY RECORDERITREASURER Tel: 541-488-5307 20 E Main Street Fax: 541-552-2059 Ashland, Oregon 97520 TTY: 800-735-2900 www.ashland.orms Jackson County, Oregon COUNTY CLERK miz K Christine Walker COUNTY CLER (541) 774-61 6147 ELECTIONS (541) 774-6148 August 18, 2016 Barbara Christensen City of Ashland Re: Petition: AshcitycouncilI; Ashland City Council Pos. 1, Doug Burns 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 30 signatures of active registered voters in the City of Ashland. 3>- g 1~ 4~4 rtC. Harvey, CIA Date Elections Program anager Jackson County Fax (541) 774-6140 Elections 1101 W. Main St., Suite 201 Medford, Oregon 97501 County: JACKSON Petition Signers Report Date : 8/17/2016 10:56:58 AM User Name : Temp, Naiobi Number :ashcitycouncill Title :Ashland City Council Pos 1 Doug Burns COUNTY • JACKSON SUBMITTAL : Submittal 1 SAMPLE : 1 Page Line Voter Id Name Current Residence Current Precinct Status Verification Reason 1 1 100530008 BURNS, DOUGLAS GEORGE 77 CALIFORNIA ST 4 007 Accepted Valid Signature 1 2 300385543 STARFIELD, 1360 QUINCY ST 007 Accepted Valid Signature MARIE-CHRISTINE 1 3 18227050 WINDROTH, STEFAN W 686 NORMAL AVE 013 Accepted Valid Signature 1 4 18146557 CANAPE,ROBERT L 182 E NEVADA ST 004 Rejected Signatures Do Not Match 1 5 200062031 HEMINGER, MARK R 1362 QUINCY ST 007 Accepted Valid Signature 1 6 18095831 BENNETT, JUDITH N 40 GRANITE ST 1 002 Accepted Valid Signature 1 7 300397293 CHITWOOD, RACHEL LEA 468 B ST 8 004 Accepted Valid Signature 1 8 300144161 GOOD, HEIDI ALTHEA 321 CLAY ST 15 013 Accepted Valid Signature 1 10 18107840 RHEAULT,ROBERT C 7562 RAPP LN 080 Rejected Out of District 2 1 100154845 CHENJERI, JONATHAN P 725 TERRA AVE 7B 013 Accepted Valid Signature 2 2 200126556 BURTON,NISHA 285 TALENT AVE 082 Rejected Out of District 2 3 18182461 MOORE, CAROL G 509 SCENIC DR 002 Accepted Valid Signature 2 4 100549605 RUTTER, TIM 516 GRANITE ST 002 Accepted Valid Signature 2 5 18097647 HARRISON, KENT MICHAEL 810 GARDEN WAY 007 Accepted Valid Signature 2 7 18179147 GRIMALDI, FOX 245 TOLMAN CREEK RD 33 013 Accepted Valid Signature 2 8 18194993 SMITH, BRUCE WAYNE 820 ASHLAND ST 007 Accepted Valid Signature 2 9 18204614 FREEMAN, SUSAN ELLEN 673 SISKIYOU BLVD 004 Accepted Valid Signature 2 10 300145372 STONE, PAUL P 77 N MOUNTAIN AVE 004 Accepted Valid Signature 3 1 100617962 BURNS, RIKHAEL DOUGLAS 77 CALIFORNIA ST 12 007 Accepted Valid Signature 3 2 300376964 ELROD, KAYLA CORLETT 77 CALIFORNIA ST 12 007 Accepted Valid Signature 3 3 18096515 ADLEMAN, ALAN R 886 A ST 004 Accepted Valid Signature 3 4 18123270 ROVIN, JACKI B 15 WINBURN WAY 1 002 Accepted Valid Signature 3 5 300335039 FOWLER,MARY JANET 390 KEARNEY ST 002 Rejected Inactive Other or Reason Not Known Oregon Centralized Voter Registration Page : 1 County: JACKSON Petition Signers Report Date : 8/17/2016 10:56:58 AM User Name : Temp, Naiobi Number :ashcitycouncill Title :Ashland City Council Pos 1 Doug Burns COUNTY : JACKSON SUBMITTAL : Submittal 1 SAMPLE : 1 Page Line Voter Id Name Current Residence Current Precinct Status Verification Reason 3 6 200064442 NUESSLE, WILLIAM 1516 OREGON ST 007 Accepted Valid Signature 3 7 300190582 HORWITCH, LISA ROSE 394 STARFLOWER LN 004 Accepted Valid Signature 3 8 100446330 HALVORSEN, AUSTIN R 1361 QUINCY ST 15D 007 Accepted Valid Signature 3 9 18174357 MAAG, MICHAEL K 585 ELIZABETH AVE 004 Accepted Valid Signature 4 1 300356955 MATTINGLY, JOHN WALTER 579 RAY LN 007 Accepted Valid Signature 4 2 18125120 FREEMAN, HOLLY 1215 TOLMAN CREEK RD 013 Accepted Valid Signature 4 3 100161608 READE, JEFFREY LANDOR 472 LINDSAY LN 004 Accepted Valid Signature 4 4 100483846 HOUSER, THOMAS JOHN 185 B ST 004 Accepted Valid Signature 4 5 100449622 KONN,JANNETTE ELLEN 73 GARFIELD ST 007 Rejected Inactive Other or Reason Not Known 4 6 16812190 BEACH, LISA F 496 BEACH ST 007 Accepted Valid Signature 4 7 300389446 PESCETTI, NATALIE 500 POPLAR PL 004 Accepted Valid Signature 4 8 18180220 EVERGREEN,AMI C 1251 OLD HWY 99 S 018 Rejected Inactive Other or Reason Not Known 4 9 100650327 RADHAKRISHNA, NINA JO 435 HOLLY ST 9 002 Accepted Valid Signature 4 10 300293852 REID,RUTH ALEXANDRA 573 SCENIC DR 002 Rejected Rejected - Duplicate Oregon Centralized Voter Registration Page : 2 County: JACKSON Petition Signers Report Date : 8/17/2016 10:56:58 AM User Name : Temp, Naiobi Number :ashcitycouncill Title :Ashland City Council Pos 1 Doug Burns Summary Results For Petition ashcitycouncill Petition Title Ashland City Council Pos 1 Doug Burns Circulation Start Date : 08/10/2016 Circulation End Date 08/17/2016 Signature Count Required 25 ACCEPTED 30 REJECTED 7 Total 37 Oregon Centralized Voter Registration Page : 3 Petition Submission SEL 338 005 01/14 Candidate, Voters' Pamphlet -01 -0 OAR 165-010-0005, 165-014-0005 This form must be completed and filed with each submittal of signatures. Filing Officer E1 State El County for both county and district petitions city Election Type Year fT-I]Primary Lq General Special Election 2014 ~ 2016 2018 Petition Information Candidate Name or Measure Number 'DoVG L)R Ij S Type of Filing Number of Signatures Submitted 4 Candidate Nominating Petition ❑ Voters' Pamphlet, Candidate `J ❑ 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 ! ~l,~kS - ~RrJS 9/7-5/2'(530-` +5,0 bUv-nS&I-tmailCa ignature Date Signed A O13 lla ~~sal6 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 D~~c xd-- . AUG 12 16 .~rl A 1nd30 Jtt B Y. LNnV ►~os~+~dr 91 :Z1 Wd 5 I C11ilv 9101 j 1i. 1~J3t! gt)n32?o'1.1000 NM"r Candidate Signature Sheet Nonpartisan Petition iD-~1(0 Signatures for this petition are being gathered by ❑PAID Circulators J4YOLUNTEER 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. y Candidates should allow ample time for the verification process to be completed before 5pm on the filing deadline day. Count Candidate 7riformatibn Name Office Election ~ ~ ~ ~ o,^ o f r ~1 ~ ~A District or Position Number 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. 9 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 /p /ag~ 16 XLA5 U.~UIeRI 5 `1 CNJ i; 02 1 to s-: 2 g 1d E_ &Tno"rtb D u iAl C S. S 7 3 \A) c " /00 'i L 1301 16 -T -5k- A4 Lk') 2-o X06 0.,P- / 82- CIL t1 ~I 75zz 5 I bI VV\ b&I k I-b i i' 3 a Q ► sr. f4 s~, I a.,l d(~ S a~ 6 I L Ai i44/\. ~VtVt~-~ 0 l~~ N I c' S a.u tz~l ~ 8- ' I o o 3 2\ c Gt S ~Z 9 IL, I 1;~ a . 1~3s6 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 p tition (ORS 49.061). I o he ^y certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. ~ ~a 6 Circulator natu a Date Signed mm/dd/yy Sheet Number ' 44~~ r7~ 7 f y/ , I~ , p Sheet will be numbered by l J~? l1~~ 1 l 11 JQCJ~ ~f~ ~ ~ 1 i c5* 711 ~/e I s~ group o submitting the 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 Signatures for this petition are being gathered by ❑PAID Circulators J&OLUNTEER 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 Infornration Name Do U. a~S Office iJ /J t(i~ /U a410( Election 4~ I Q'^ Q r~ ~ ~ TA District or Position Number 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 s1~1 I J VZ 9 ZO Atn J ! 3 em" M ao re 50 4 aN J( /T 1 O FN S tt L_ 6 ib ay Tol>n cr~~~ ,~3~ s to ►1.cLGe k) n a- 9 f I Al- , so ~ Ae-v7(-4 -,x-" 1~yl~ Circulator C ifl n 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 (0 249 61). also hereby certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. 0 8 x 2 'l 6 ~ Circulator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by group submitting the - e ~Sii L 7Z N petition. Printed Name of Circulator Circulator's Address street, city, zip code SEL 121 rev of/14 ORS 249.072 County Elections Officials provide a separate certification to attach to the petition, Candidate Signature Sheet I Nonpartisan Petition lD".~~ Signatures for this petition are being gathered by ❑PAID Circulators J&OLUNTEER Circulators This is a candidate nominating petition. Signers of this page must be active registered voters in the county listed. l 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 D t~ 5 Office /J rTy/ r Election District or Position Number za: 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. Signature Date Signed mm/dd/yy Print Name Residence or Mailing Address street, city, zip code IZN Z C-0 SY(A« S4-, *V (2,41-j 2 F1 m (-e 6-4-1-1-1 '77 s l I !9 zli U S4 14s - f-acs-. TaCKI, / / bnr-n 4 Aix' , ~ V- SA 75 So-L,,t Eve?w% 6 s &,'v/orsen L361 40 aldNC4 9 /1 e, HI WAX- PIA-4r, V I Cir ator Certification This certification must be completed by the circulator and additional signatures should not be collected on this sheet on he certification has been signed and dated! I hereby certify that I witnessed the signing of the signature sheet by each individual whose signature appears off the signature sheet, and I believe each person is a voter qualified to sign the et!t!on ( 49.06 .1 also hereby certify that compensation I received, if any, was not based on the number of signatures obtained for this petition. Cg' o20/C~ V Circulat Date Signed mm/dd/yy Sheet Number S ature A f ,~f Sheet will be numbered by \ d^51f6Lk5- 613UK IV ( ~r~ v l 1 ~/7~7/vQ~V~ - T~So~-sc1 BrouPPetitioningthe 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. 141idate Signature Sheet Nonpartisan Petition ID ('"C141 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 Candidate Information Name Do ` A5 Office Election District or Position Number //4'O w• ~W\ ~ / 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 C)g ( -5-C) kt U 141(1~ 57 9 S (a ~l 2 v'l, 1 1 {'w I -~~~~a J a s h lwa G~ S44--7 3 -Z- 7 SUD Cog II (P eS~ nr lase f}sllond t4-t, Z l K( 0 ( 1~ ~b 2~ Circulator Certification This certification must be completed by the circulator and additional signatures should not be collected on this sheet once the certification has b igned an 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. i LG/~h-2rU 0812 A16 Circulator Signature Date Signed mm/dd/yy Sheet Number Sheet will be numbered by -;77 group submitting the 7 ZO petition. Printed Name of Circulator Circulator's Address street, city, zip code SEL 121 rev 01/14 oiu 249.072 County Elections officials provide a separate certification to attach to the petition.