Lund, Scott - Mayor FORM(RglM PO gip)MILLER-DAVIS CO.,ST.PAUL,MN
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN.OR CITY ELECTIONS
State of Minnesota No. C�L
County of 6Y A I
ss.
(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 ZQXA 1&>0—
I reside in the City or Township of 6lLlOIL-fs d
My post office address is 9 rlw A r<-.
N• ..yc�._ (zip) �S_5 32-
y
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✓ � (Sign name anted on ballot)
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City of Fridley Nomination Petition
ROM,
We,the undersigned,registered voters of the City of Fridley,hereby nominate _j,-- ,
<� "" �-- f ,
whose residence is ��� �� � ,J(1� or the office of �Y�k � t' to be
voted for at the election to be held on the day of u)� ,2000; 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: Printed Name and Signature Address
7 /0 OCA -�f\
owAr {' 1O1Q _ CkA'"I 1f06K t.(/
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in
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y��;, 1 i/d-C ,being duly sworn,deposes and says,"I 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 by name to appear on the ballot exactly as follows:
(Please Print Name) 1
This petition,if found insufficient by the City Clerk, shall be returned to SUR L 14 LO at
Fridley,Minnesota. I hereby indicate my willingness to accept the
office of if duly elected thereto.
(Signature of N mine)
Sibscribed and sworn to bef e this day o ,2000.
,. RUTH MARCELLE EVERETTE
otary Public) - NOTARY PUB r.-u soTA
MY COMMISSION EXPIRES
r JANUARY 39,9-W5
ri
City of Fridley Nomination Petition
CI YOF
FR[DLEY
We,the undersigned,registered voters of the City of Fridley,hereby nominate rJ,fl
whose residence is 616PO - for the office of 0,o to be
voted for at the election to be held on the�_day of G ,2000; 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; Printed Name and Signature Address
lrnw
J:�y�z
i o a Lori &e - JUFL Er d L
QV�7.,
Um Ala
r'7 4-_DO S oo R iIC reg 4 ii i �e fi
�4�
SL u ? ,being duly sworn,deposes a says,"I 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 by name to appear on the ballot exactly as follows:
fG o 77- 414>✓D
(Please Print Name) n /
This petition, if found insufficient by the City Clerk,shall be returned to J"V L U d U at
6-OR0 , q 74 4 e<-.- ,Fridley,Minnesota. I hereby indicate my willingness to accept the
office of /WA?/p if duly elected thereto.
(Signature of No inee)
S cribed nd sworn to por
me this day of ,2000.
(Notary Public) ��A��'�jLE �°�
NO pR_ L r'"WNESOTA
MY COMM1 SIGN apIRES
n
City of Fridley
Public Disclosure Statement
By City Council Members or City Council Candidates
Name: Date
Position Title:
In conformance with Section 5.04 of the Fridley 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 one 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, Address Financial Interest Personal I iterest
Partnership,Etc.
(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:
Non-Homestead Real'Property Address
(use additional paper if necessary)
r� ^
3. A list of the non-homestead real property located within the City of Fridley in which I have had
a financial interest within the proceeding three years.
Nan-Homestead Real Property Address
� r
(use additional paper if necessary)
4. A list of 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.)
Nature of Business—of'All Corporations,
Names partnerships,or Other Business Enterprises
(Use additional paper if necessary)
I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.04 of the
Fridley City Code.
(Signature)
Note: This statement must be filed annually or when there is a material change in financial interest or'in position held.