Stahlberg, Al - Ward 3 FORM 11(REVISED 1980)MILLER-DAVIS c0..MINNEAPOLIS
y AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
State of Minnesota No.
f�.
County of A/V rD�
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.30 days by election dayears • ooffice I have f filed for any other leastoffic
err oce at this election resident of my election district for at
I am seeking election to the office of 06 V ou ce A '�
I reside in the city or township of 4
My post office address is: V995"5- t�E v f C W
(ZipA'' V Y Z
(Sign na as wanted on ballot)!
Subscribed and sworn to before me this day of 1
%fary Margaret Smi (Tow (City ler —Notary Public
r
NOTAR`!PUBLIC-MINNESOTA County,Minn.
SEALrNTY
,yNOKExp Ir 28,1997
"36,,•m'd
NOMINATION PETITION
We, the undersigned, registered voters of the City of Fridley,
hearby nominate 11AZL1 S7,4
whose residence is
for the office of
0 U/L' ` � �4 `� , to be voted for at
the election to be held on the day of lw, 199`1 ;
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.
DATE NAME STREET AND ADDRESS
a"S_ l L ?zc�li-JZ7li S� /x C` _i 1
t
r 'l
eing duly sworn, deposes and says, "I am
(Nam/re of Circulator
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:
,4� 37-,4 h z4 _,2
(Please Pr' t)
(Signature of Nom' e)
Subscribed and sworn to before m a*,
this --"'4���'
,� �
of Maly Margaret Smith
E�®T�4RY PUBLIC-MINNESOTA
00
ANOKA COUNTY
t�Iy 1,MM.Exp.July 28, 1997
- ( ota Publ c) "."a :.. 3ad' �:ac"u� �„ia� ii;t
This petition, if found insufficient by the City Clerk, shall be returned
to at Number Street.
I Nearby indicate my willingness to accept the office of
if duly elected thereto.
(Signature of Nominee)
6/54