Lewis, Richard - Mayor FORM 11(REVISED 1950)MILLER-DAVIS CO..MINNEAPOLIS
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AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
State of Minnesota No.
JJ.
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/filled for any other office at this election.
I am seeking election to the office of < ' /A b/2,
I reside in the city or township of ��
V
My post office address is: /
(Zip) ,6 3d 3a
ign name as wanted on ballot)C�/
da f
P19
Subscribed and y or
1 JOAN M.BUDNICK
NOTARY FURC"MIIXINIM (To n) ) Clerk—Notary Public
yiponr�6wsia11.11N
SEAL County,Minn.
NOMINATION PETITION
We, the undersi registered voters of the City of Fridley,
Z
hearby nominate E�_F w2 S�j p_. , whose residence is
N.E . FAZzo,-CY 1`�°k� .S5V3� for the office of
f,VC) to be voted for at
the election to be held on the y day of4yeroj?Lq 19It( f
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
74 1
OK 71 AxE
t
� C-"-hjLO "J.-I-C. being duly sworn, deposes and says, "I am
(Name 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 n to appear on the ballot exactly ollows•
A .Lxz
(Pleas rint)
nature of Nominee)
Subscrbe and sworn to beforee this t day R.
PM-
of , 19 .
JOAN M.BUDNiCK
1)'L/- 0 WTMV F=-ABTA
y
C� WCONAM06OUJALAM
7tion,
tary Public)
This et if found insufficient by the City Clerk, shall be returned
x,21 z at Number � ( Tai} Street.
I h arb Ln icat�my willingness to accept the office of
if duly elected thereto.
ignatu f nee)
6/94
CITY OF FPJ=
C DISCLOSURE STATEMENT BY CITY COUNCIL OR COUNCIL CANDIDATES
NAME T NA6ZQ L w DATE -7
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 FINANCIAL PERSONAL
PARTNERSHIP, EIC. ADDRESS INTEREST INTEREST
(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:
NOIR-HOMESTEAD REAL PROPERTY ADDRESS
NO IV
JI
(Use additional paper if necessary.)
_ l
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:
NW-HOMESTEAD REAL PROPEFCY AWRESS _
—WO�N
(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.)
NA7.M OF BUSINESS - OF ALL ODRPORATIONS
NAMES PA M ERSHIPS, OR UMER BUSINESS ELlMd RISES
(Use additional paper if necessary.)
I do swear (or affirm) that th' eport is a full rue st ment
pursuant to Sec-. 5.04 of the Code.
Note: This statcnent must be filed annually or when there is a material
change in financial interest or in position held.