OREGON REPUBLICAN PARTY

Replacement Candidate Nomination Filing Form for House District 19

Nomination Filing Deadline: Friday June 6th 2014, 5:00 PM
I, _________________________________, wish to be considered as a candidate
for Oregon State House District 19. I have been a registered Republican for a
minimum of 180 days and have resided in House District 19 for at least one year
prior to May 20th 2014, in order to seek this office.
I pledge to uphold the laws of the State of Oregon and to faithfully execute the
Office of Republican Party Nominee for Oregon State House District 19.
Applicant Name (PRINT): _____________________________________________
Address: ___________________________________________________________
City, State, Zip: _____________________________________________________
County: __________________________________ Precinct: _________________
Home Phone: _____________________ Mobile Phone: _____________________
Email: _____________________________________________________________
Signature: _________________________________ Date: ___________________
Witness Signature: __________________________ Date: ___________________
Applications are to be submitted to ORP Headquarters
Delivered in person, via U.S. Mail, or via email by 5:00 PM on Friday June 6th, 2014
with ATTN: HD 19 Candidate Filing
ORP Mailing Address: PO Box 1586, Lake Oswego, OR 97035
ORP Street Address: 25375 SW Parkway Ave, Suite 200, Wilsonville, OR 97070
Email: executivedirector@orgop.org