Stahlberg, Al - Ward 3 FORM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
State of Minnesota TOWN OR CITY ELECTIONS
sr No.--)3 —
County Of
Tint 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.
C '
I am seeking election to the office of
I reside in the city or township of
My post office address is: If
(Zip) 5
Subscribed and sworn to before me this � � (Sign na �swan�leeodon ballot)
day of , 1v z
Tow�n '( ty) Clerk– otary Public
SEAL �o County,Minn.
i
L N MINXTION PETITION
We, the undersigned, registered voters of the City of Fridley,
hereby nominate . whose residence is
0 5" , t
& s , for the office of
IJ AjC , to be voted for at
the election to be held on the day of ti —' 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.
NAME STR T AND NUMBER
l �-
� 1 f
3 -1
iL
3- 1
, being duly sworn, deposes and says, "I
(Name of Circulator)
am the circulator of the oregoing 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:
—57/ a
(Please int)
(Signature of Nominee)
Subscribed and sworn to before me this day
of 61"her _, 19 3r
ast/t�
. 6 �i-C)TA .gip
7
This petition, if found insufficient by the City Clerk, shall be returned
to at Number ' 7 �c 4-7'Z'lz= j street.
I hereby indicate my lingness_to accept the office of
if duly elected thereto.
(Signature of Nominee'
3/0/1/9
a
NOMINATION PETITION
• We, the undersigned, registered voters of the City of Fridley,
hereby nominate 411,4 Al S 1 , whose residence is
QSARMV F a , for the office of
•
WAg 43 , to be voted for at
the election to be held on the _ l _day of ZA iy , 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.
NAME STREET AND NUMBER
Aj
1 M �
being duly sworn, deposes and says, "I
(Name of Circulator)
am the circulator of the aforegoing 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 Print)
(Signature7 of Nomin
Subscribed and sworn to before me this2--"-/) day N
of
r' >• OTA
sal f;s R 7
/ (Nota Pubi' � *as
This petition, if found insufficient by the City Clerk, shall be returned
to -- } C ' `�° , at Number 'L">5 ��1 Cif w Fey' Street.
I hereby indicate my willingness to accept the office of CL6 7wCv�.
if duly elected thereto.
(Signature of
3/0/1/9