Fitzpatrick, Ed - Ward 3 FORM 11(REVISED 1980)MILLftR-DAMS CO.,-p OLISg,-
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AFFIDAVIT`{ CAN 0 IZECEIPT' F012 FILING
TO � LECTIONS
State o Minn sota
No.
County of
(Print name as wanted on ballot)
swear(or affirm) that I am qualified under the Constitution and Laws of the United States and State of Minne-
sota to seek the elective public office indicated below. I am a qualified voter in the subdivision where I seek
election. I will be 21 years of age or more on assuming office. I will be a resident of my election district for at
least 30 days by election day. I have not filed for any other office at this election.
I am seeking election to the office of_
I reside in the city or township of �.
My post office address is: �7
( ip) � Sya�
X27' ign name as wanted on ballot)
Subscribed day of C.J
CLYDE V.MORAVETZ - ,/�
ANOKA COUNTY own), (City) Clerk—N ary Public
21
SEAL *1 Omn E*.Jan.24,19" _,_/V 0%,
` T County,Minn.
i
NOMINATION PETITION
We, the undersi istered vo s of the City of Fridley,
hereby n ' t whose residence is
!J Z : 00, - ,
0 09
, for the office of
to be voted for at
49
the election to be held on the day of 19 �Fd;
and we individually certify that we are registered oters and that we
have not signed more nomination petitions of candidates for this office
than there are persons to be elected thereto.
p� RM SIIWM AND NUMBER
1317Fz3 Ig .
7 M'I
/J
NE
67J/7 aylk
jC j ea?" r-., c /{ , being duly sworn, deposes and says, "I
(Name of Circulator)
am the circulator of the foregoing petition paper containing signatures,
and that the signatures appended thereto were made in my presence and are
the genuine signatures of the persons whose names they purport to be."
I wish my name to appear on the ballot exactly as follows:
Z 2-f r- i c ISG.
( lease PrintAOI
(Si ture o )
Subscribed and sworn to before me this .� day CLYDE V.
of u L y , 19-zo--. WrAW PUM c• A
waam
x
(Notary Pub1i
This tit' , if found insufficient by the City Clerk, shall be ret ned
�r2 2.
&jg..at Number
here cate my willingness to accept the office of
PM if duly elected thereto.
( re o )
3/0/1/9
I
i
I
CITY OF FRMLEY
DISULJUJ PTATEME!U BY ITY IL OR QOU ILIATE.S G
NAT TYNE /`1
TO: CITY CLERK
In conformance with Sec. 5 . 04 of the City Code, I hereby make the following
declarations regarding my financial and personal interests:
1. Names of all business corporations, partnerships, other business
enterprises, or governmental agencies doing business with the City of
Fridley or located within the City of Fridley:
a. With which I have a financial interest.
(As used in Chapter 5 , the term financial interest shall be deemed
to include ownership of more than 10% of: The outstanding stock in
a corporation, an interest in a partnership, proprietorship, or
other business entity, or an interest in real property. Financial
interest shall apply to real or personal properties owned by the
person making the disclosure and by said person's spouse.)
b. With which I have a personal interest.
(As used in Chapter 5 , the term personal interest shall be deemed
to apply whenever a person required to make a disclosure under this
code of ethics shall be associated with a business as an employee,
officer, director, trustee, partner, advisor or consultant.)
NAME OF BUSINESS FINANCE PERSONAL
PARINMSHIP, ETC. ADDRESS INTEREST IMrEREST
(Use additional paper if necessary.)
2. A list of the non-homestead real property located within the City of
Fridley in which I currently have a financial interest:
NON-HOMESTEAD REAL PROP'ER'TY ADDRESS
(Use additional paper if necessary.)
3. A list of the non-homestead real property located within the City of
Fridley in which I had a financial interest within the preceding three
(3) years:
NON-HaCSTF.AD REAL PROPERTY ADDRESS
(Use additional paper if necessary.)
4. A list of the names and nature of business of all corporations,
partnerships, or other business enterprises with which I have a
financial interest and in which I know one or more other persons covered
by this code of ethics also having a financial interest in said
enterprise. (This list shall indicate the name or names of such persons
or persons having such interest in said enterprise.)
NATURE OF BUSH SS - OF ALL CORPORATIONS
NAME'S PAKIERSHIPS, OR OTHER BUSIlMS ERrMPRISES
(Use additional paper if necessary.)
I do swear (or affirm) that this re is a ful and true statement
pursuant to Sec. 5. 04 of the C!tYe
(Si re)
Note: This statement must be filed annually or when there is a material
change in financial interest or in position held.