Barnette, Bob - Council at Large FORM11JREVISED1980 kyLLER-DAVISCO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
Stateof Minnesota No.
County of—d"__
RR
(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_ �C
My post office address is: `'`//
d�i✓l t (ZIP)
Y na
,p
(Sign me as wanted on ballot)
Subscribed and sworn to before me this z day of ` 19
own) it )'Cler – otary Public
SEAL County, Minn.
mmiw ioN PETITION
we, the undersigned# registered voters of the City of Fridley,
hereby nominate &6 whose residence is
_6-L7// A/CC-7 C4� �x 6 L V1) N• for the office of
60 �� � —9 �T -/J 2 , to be voted for at
da �D ✓ . 9�
the election to be held on the Y of 19
and we individually certify that we are registered voters and that we
have not signed more nomination petitions of candidates for this office
than there are persons to be elected thereto.
STPZ -r AND
X90 j
Ss-z) .v j7
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:
Tt3c��3 /3,4/&VV/ -/7�
(Please PriptY
4(ASiLgnat re of Nominee)
Subscri and sworn to before me this /s� day
of 19-2HARRIET A.JOHNSON
NOTAM PUBLIC•MIMES
t.%t��c�J HENNEPIN COU
(Notary ic) , ,ownmwW cx� .
This petition, if found insufficient by the City Clerk, shall be returned
to 5clo' ��> �= _ at amber 7__ �� ee .
I hereby indicate my willingness to accept the office of
L,&1nlc'1L)/4A) Gt if duly elected thereto.
(Signa re of Nominee)
3/0/1/9
a
S ` e
We, the undersigned, registered voters of the City of Fridley,
hereby nominate 130,8 08 gQ��j . whose residence is
C2&-E7e i3L,V0 iV• for the office of
Coc>n/cjL-/" 6to be voted for at
the election to be held on the day of /✓o , 19 L-
and we individually certify that we are registered voters and that we
have not signed more nomination petitions of candidates for this office
than there are persons to be elected thereto.
NUMBM
1�
f..,7
i
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:
(Please Pr'
(Signat re of Nominee)
Subscrib d sworn to before me this ZSL day
of , 19 r z�- . �1MWMF77n
UNTY�,'}, Oct, i 5��3
(Notary Puo 'c)
1111444
This petition, if found insufficient by the City Clerk, shall be returned
to 130/3 /BARIV451 l c , at Number S-41/ lei'/C4F CK 6 L V-0 Street.
I hereby indicate my willingness to accept the office of
C-Ocwo t,, 1006 en 1q7- JAl16e duly elected thereto.
-)(Signature of Nominee)
3/0/1/9
y . _
CITY OF FRIDLEY
PUBLIC DISCIDSURE STATEN= BY CITY COUNCIL CIt 00UNCIL CANDIDATES
NAME ,�U�j �T 16AI A11-�- DATE
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, pa
rtnerships, other business
enterprises, orwithinnal agennccieoss doing business with the City of
Fridley or located
f 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,
offioer, director, trustee, partner, advisor or consultant.)
NAME OF BUSINESS FINANCIAL PERSCNAL
PARMERSHIP EIC. AD .S INTEREST IlRI'EREST
/✓ �
(Use additional paper if necessary.)
2. A list of the norr-homestead real property located within the City of
Fridley in which I currently have a financial interest:
NON-HOMESTEAD REAL PRCpERTY ADDS
NNL
(Use additional paper if necessary.)
A
., a. .. A
3. A list of the non-hanestead real property located within the City of
Fridley in which I had a financial interest within the preceding three
(3) years:
NON-HnMERTEM REAL PROPERTY ADDRXSS
(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.)
MTURE OF BUSINESS - OF ALL QURPOPMIONS
NAMES PAMNERSHIPS, OR MER BUSINESS WMRPRISES
o N`
(Use additional paper if necessary.)
I do swear (or affirm) that this re rt i full an true statement
pursuant to Sec. 5.0 4 of the City ;
(Signature)
Note: This statement must be filed annually or when there is a material
change in financial interest or in position held.