HomeMy WebLinkAbout(Incomplete Filing) Bangsberg FILING OF CANDIDACY FOR NONPARTISAN NOMINATION
PLEASE TYPE OR LEGIBLY PRINT IN BLACK INK.
NOTE: This information is a matter of public record and may be published or reproduced.
OF
NAME OF CANDIDATE DISTRICT, DEPARTMENT OR POSITION NUMBER
NAME SHOULD APPEAR ON BALLOT AS FOLLOWS RESIDENCE ADI~ESS (STREET/ROUTE, CITY,~TE, ZIP CODE)
TELEPHONE (HOME) T~LEPHONE (WORK) COUNTY OF RESIDENCff'
FILING FEES
FILIN _C~OI~/qDIDACY BY DECLARATION ,Ill SJ, ATE VOTERS' PAMPHLET
c-,~?~/~(ORS 249'056) ~ ~ V (ORS 251.095,
OFFICE ~A~/ \
STATEWIDEOFFICES \~ F/ $100 ~"~. /~ b $1000
~D EXECUTIVE OFFICER, MSD AUDITO/ $100
MSD COUNCILOR / $25
COU~ OFFICE / $ 50
CI~ OFFICE * ~J )0
JUSTICE OF THE PEACE / NONE
· ~, By Charter or Ordinance ** For Cities With a Population of 50,000 or More (ORS 251.¢
one or more circu~tors will or will not be paid (SEL 300) (0~ 249.020).
/
~ Fil~g of c~y by ~ p~2i~, with t~ required signature sheets properly certified by the appropri~ons
Prima~ Election 2002 FILING DATES General Election
Deadl~e to Withdraw Candidacy: March 15, 2002 Deadl~e to Withdraw C~didacy: August 30, 2002
Fling For State Voters' Pamphlet: March 14, 2002 Fil~g For State Voters' Pamphlet: August 27, 2002
FOR OFFICE USE ONLY
INITIALS CASH OR CHECK NUMBER
RECEI~ NUMBER CANDIDA% ID NUMBER
O~ICE NUMBER P~NCIPAL CAMPAIGN COMMI~E ID
SEL 120 REV. 11/01 ORS 249.031
REQUIRED INFORMATION
OCCUPATION (PRESENT EMPLOYMENT- PAID OR UNPAID) /~)~, o"~ T¢0o~2.~-.~a~ i,~ ~. ~}(~-
OCCUPATIONAL BACKGROUND (PREVIOUS EMPLOYMENT - PAID OR UNPAID)
EDUCATIONAL BACKGROUND (SCHOOLS Al'l ENDED, use attachment if needed)
Course of study (optional)
Complete name of school - no acronyms
Other:
Last grade level
completed
Diploma/Degree/Certificate
(AA, BA, BS, MA, PhD, etc.)
PRIOR GOVERNMENTAL EXPERIENCE (ELECTED OR APPOINTED)
NOTE: This information is a matter of public record and may be published or reproduced.
this document, I hereby state:
THAT I shall accept the nomination for the office indicated above; - -
THAT I shall qualify for said office if elected; and
THAT all information provided by me on this form, including my occupation, educational and occupational background, and prior
governmental experience, is true to the best of my knowledge.
Date signed
f a felony with a fine of up to $100,000 and/or prison for up to five
No person shall file a nominating petition or declaration of candidacy for more than one lucrative office before the date of the primary election, unless
the person first files a written withdrawal with the officer who accepted the filing (ORS 249.013(2)).
SELl20 REV. 11/01 ORS249.031
STATEMENT ONE OR MORE PETITION CIRCULATORS WILL BE PAID
I/We hereby declare one or more petition circulators will be paid money or other valuable consideration for obtaining
signatures of active registered voters on the attached petition or certificate. I/We understand the filing officer must be
notified not later than the tenth day after I/we first have knowledge or should have had knowledge that no petition
circulator will be paid for obtaining signatures.
Identify Petition
(Name of Candidate or Minor Political Party on Prospective Petition; or Subject of Initiative, Referendum Petition or
Name of Officeholder on Recall Petition)
Signed* Date signed
Date signed
Date signed
*Statement must be signed by one of the following: · candidate for nomination;
· all chief petitioners for initiative or referendum petition;
chief petitioner for recall petition;
· chief sponsor for certificate of nomination; or
· chief sponsor for minor political party formation petition.
STATEMENT NO PETITION CIl
S WILL BE PAID
I/We hereby declare no petition circulator will be [
active registered voters on the attached petition or
than the tenth day after I/we first have knowledge or
be paid for obtaining signatures.
other valuable consideration for obtaining signatures of
/We understand the filing officer must be notified not later
have had knowledge that one or more petition circulators will
(Name of Candidate or Minor Political
N
Signed* ~
pective Petition; or Subject of Initiative, Referendum Petition or
of Officeholder on Recall Petition)
*Statement must be signed by opel following:
· candidate for nominatij~n;
· all chief petitioners f~initiative or referendum petition;
- · chief petitioner for ¢~call petition;
· chief sponsor for certificate of nomination; or
· chief sponsor for minor political party formation petition.
SEL 300 REV 11/01
ORS 248.008, ORS 249.061, ORS 249.078, ORS 249.740,
ORS 249.865, ORS 250.045, ORS 250.165, ORS 250.265, ORS 255.135