Jorgenson, Nancy - Mayor FORM II(REVI.�FD ISSO)MILLER-DAVIS CO..MINNEAPOLIS
~ AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
Stat of Minnesota No.-�—
ss.
County of
I, D RII SU
(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 e
My post office address is:
1-e!+ (zip)
( gn ame as wanted on ballot)
Subscri re me this
da f , 19
ROBERTA S.COLLINS
Y PUBLIC-MNMWMA own),( ity)Clerk—Notary Public
NOTARNilEJiOfA
. ANOKA COUNTY _County,Minn.
SEA MI►Comm.Exp.Jan.!t.M
t
AffidavitI
of Candidate
Filed in the office of the
-------------------------------------------------
----—--------------- ----of -------------------- ---
Countyof ----------------------------------------
Minnesota, this----------------------------,day of
----------------------------------A. D. 19------
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MILLER DAVIS CO., MINNEAPOLIS
NOMINATION PETITION
We, the undersigned, registered voters of the City of Fridley,
1
hearby nominate U �J�� � , whose residence is
for the office of
to be voted for at
�J
the election to be held on the day of f'r 19i'`!� ;
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.
PAU NAME STREET AND A=ESS
o�, -7 ��o4, Z
Lj
JY. -�;Z'--r-9' �` ✓ J���
oV t- I Y G-
w
Q , being duly sworn, deposes and says, "I am
*(Naeof Circ tor)
the circulator ofthe -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. '1
I wish my name to appear on the ballot exactly as follows:
a e �
(Ple Print)
(Si tur o Nominee)
Stzb ib d and sworn to before/�m/e this � day
of 19 lfo _
Q R08ERTA S. COLLINS
NOTARY
OKA IC Miraeso-.t
otar Public CCUNTY
y ) My Comm.Exp.Jan.'z i,Z-00
This petition, if found insufficient by the City Clerk, shall be returned
to Q S Sa 4 , at Number 5'730 k S� IU.F. �d r� K? �
I hearby indicate my willingness to accept the office of i �l
If duly elected thereto.
/1i'9ttujeqolplie4n_et�)
6/94
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