Hardy, Adam - Council at Large (7b3) 7l—OPW7
FOROMEVISED 1990)MILLER-DAVIS CO.,ST.PAUL,MN
AFFIDAVIT OF uANDIDATE & RECEIPT FOR FLING
TOWN OR CITY ELECTIONS
State of innesota No.
SS.
County of
I,
(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 P
WxLiA,41 meiu6er—
I reside in the City or Township of
My post office address is Lyf- e"41 PA-
(zip) 3 a—
dc
(S gn name af wanted on ballot)
Subscribed and sworn to before me this day of
k-4'41ai4�� .(Town), (City)Clerk—Notary Public
SEAL oqlCounty,Minn.
ri
City of Fridley Nomination Petition
FF D�
We,the undersigned,registered voters of the City of Fridley,hereby nominateam
c�
� rw+�w►Iffier-
whose residence is bXgC Ck"ne/ Rd. �, for the office of - ,to be
voted for at the election to be held on the _day of tJeJ"cr ,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 Acidness
Acidness
Lo Doo fir` cO
�✓ 7-�3 c�c� �u� „Q,%ik6Arn G y3o .�7 1i flue_ NE nQll IF
,yJ 7-J3.0c-3 L a �t�3y '6 Allo i Ir l2°
_�3 d0 j e-.ssj r� Flwi !an
being duly sworn,deposeays,"I am the circulator of the foregoing
petition paper conta ning 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 b name to ap ar on the ballot exactly as follows:
(Please Hint Name)
This petition,if found insufficient by the City Clerk, shall be returned toA.'j, at
kaAh@� 400-1 E ,Fridley,Minnesota. I hereby indicate my willingness to accept the
office of �"��� Wks er- if duly elected thereto.
f- dAcx4f
(gig nature Nominee)
Subscribed and sworn to before me this &-day of�,2000.
otary Public) JESSICA L EBUI�G
$3 ' NOTARY PUBLIC PAINNESOTA
MY Comm.Expires Jan.31,2005
ri
City of Fridley Nomination Petition
CIiYOF
FROLEY
We,the undersigned,registered voters of the City of Fridley,hereby nominate
Alm
whose residence is rr? r (�' , for the office of y e
voted for at the election to be held on the _day of A-')b0a-&ef— 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: PrintedName and Signature Address
f�—�3 -,?000 C'�ARCes gs c�ec�d C% o '- -6-' AWF At E 2r�fC
3
s . WE 4't- Abse �f � �., �R�Dc ,+-,n�✓
/3-levo LahaFree bi4Yr1 AA9
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4art*�j being duly sworn,deposes and says,"I am the circulator of the foregoing
petition paper cont ai ng 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 byme to appe on t e ballot exactly as follows:
(Please Prin Name)
This petition, if found i sufficient by the City Clerk, shall be returned to at
Fridley,Minnesota. I hereby indicate willingness to acc t the
office o A 'f duly elected thereto.
(Signature of Nominee)
Subscobfd and swo to efore me this day of 000.
w DEBRA A.SKOGEN }
(NO Public) NOTARY PUBUG-A INNE50TA
MY COMMISSION EXPIRES
jANUARY 31,2005
City of Fridley
Public Disclosure Statement
By City Council Members or City Council Candidates
Name: Date d C�
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 Interest
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
L
(use additional paper if necessary)
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.
Non-Homestead Reat Property Address
(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.