Filing of Candidacy for Special District Nomination SEL 190 rev 01/10: ORS

Transcription

1 Secretary of State Elections Division 255 Capitol St. NE, Suite 501, Salem, OR p f Filing of Candidacy for Special District Nomination SEL 190 rev 01/10: ORS This information is a matter of public record and may be published or reproduced. Candidate Information Candidate Name Filing for Office of How Name Should Appear on Ballot District, Position or Zone Number if applicable Residence Address, Street/Route City State Zip Code County of Residence Home Phone Work Phone Cellular Phone Fax Address Date of Election Mailing Address where all correspondence will be sent, Street/Route City State Zip Code Filing Information Filing of candidacy by declaration, with the required $10.00 fee. Filing of candidacy by petition, with the required signature sheets bearing the signatures of at least 25 electors or at least 10% of the electors residing in the electoral district for the office (whichever is less), certified by the appropriate county elections officials. Required Information (if no relevant information, list none ) Occupation present employment paid or unpaid Occupational Background previous employment paid or unpaid Educational Background schools attended, use attachment if needed Complete Name of School no acronyms Last Grade Level Diploma/Degree/Certificate Course of Study Completed (AA, BA, BS, MA, PhD, etc) optional Other: continued on the reverse side of this form SEL 190

2 Required Information (if no relevant information, list none ) Prior Governmental Experience elected or appointed By signing this document, I hereby state: that I will qualify for said office if elected 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 Check the applicable box: By marking this box, I certify I do not have an existing candidate s committee and I do not expect to spend more than $350 or receive more than $350 during each calendar year. I understand I must still keep records of all campaign transactions and if total contributions or total expenditures exceed $350 during a calendar year, I must follow the requirements detailed in the Campaign Finance Manual. By marking this box, I certify that I have already filed or will soon file a Statement of Organization for Candidate Committee (SEL 220). For detailed instructions, see the Campaign Finance Manual. Candidate s Signature Date Signed This information is a matter of public record and may be published or reproduced. 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 ) No person may be a candidate for more than one district office, unless the district has less than 10,000 electors residing in the district. No person may be a candidate for more than one position on the same board to be filled at the same election. (ORS ). For Office Use Only Initials Cash or Check Number Candidate ID Number Receipt Number Office Number

3 The candidate is not required to establish a campaign account, file a Statement of Organization or file contribution and expenditure transactions, if all three of the following conditions are met: the candidate serves as the candidate s own treasurer the candidate does not have an existing candidate committee and the candidate does not expect to receive or spend more than $350 during a calendar year The $350 includes personal funds spent for any campaign related expenses, such as any costs related to circulating a nominating petition, paying the candidate filing fee, paying any Voters Pamphlet filing fee or cost of a Voters Pamphlet portrait. If the candidate exceeds $350 in either contributions or expenditures, the candidate must establish a campaign account and file a Statement of Organization within three business days after exceeding the threshold. Additionally, all contributions and expenditures made during the calendar year must be filed electronically not later than seven calendar days after the threshold has been exceeded. Deadline to File Statement of Organization The Statement of Organization must be filed within 3 business days of receiving a contribution or making an expenditure, but no later than when the completed petition is filed.

4 District Petition Signature Requirements for 2011: Harney ESD 25 Crane Elem 25 Diamond 7 OO 3 Drewsey 9 Frenchglen 4 Dist 3 25 Pine Creek 4 S. Harney 9 Suntex 4 Crane UH-1J 25 Park & Rec 25 Health Dist. 25

5 Petition for Special District Nomination Signature Sheet Petition ID This is a candidate nominating petition. Signers of this page must be active registered voters in the following county: Candidate s Name District Name Office District, Position, Department or Zone Number if applicable To the County Elections Official, We, the undersigned voters, request the candidate s name printed above, for nomination to the office indicated, be placed upon the appropriate ballot at the next regular district election following the filing of this petition. Signature Date Signed mm/dd/yy Print Name Residence or Mailing Address street, city, zip code County Elections Official Certification I hereby certify in signatures on this petition are those of active registered voters in name of district County, Oregon. Signature of County Elections Official SEL 191 rev 01/10 ORS Date Certified mm/dd/yy Sheet Number