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Affidavit of Candidacy
All information on this form is available will appear on the Secretary of State's website at
to the public.Information provided
www.sos.state.mn.us• g petition-"Candidates
t a major party candidate,y petition as provided in sections
You must file both an affidavit of candidacy and a nominatin
p shall be nominated Mmn Sn�ting pon 20413.03).
Note:If filing for partisan office and k J provided in section 20413.06."
for any partisan office who do shall file an affidavit of ccandidacy the nomination of a major p ptical• r e.
20413.07 and 204B.08,and. . Please print
Name(as it will appear on the ballot):
m `S � � District#:
c
Office Sought: r✓ ��
For Partisan Office Provide Political Party or Principle:
For Judicial Office Provide Name of Incumbent:
Legal Residence Address
- f� S'• `� 3 Z—
Street Address: Stater—Zip: S
City:
Campaign Contact Information r4 i 1
Street Address: 6' 3 1 Stater Zip:
City: r--12 0
Email:
Website:
Phone Number:
For all offices,I swear(or affirm)that this is my true n )that the name by which I am generally known in the community.
If filing for a state or local office,I also swearo
• I am eligible to vote in Minnesota;
• I have not filed for the same or any other office at the upcoming primary or general election;
• I am,or will be on assuming office,21 years of age or more;
• I will have maintained residence in this district for at least 30 days before the general election;and
• If a major political party candidate,I either participated in the parry's most recent precinct caucuses or intend to vote for a majority of that party's
candidates at the next general election.
)that I meet the requirements listed below:
If filing for one of the following offices,I also swear(or affirm
• United States Senator-I will be an inhabitant of this state when elected and I will be at least 30 years old and a citizen of the United States for not
less than nine years on the next January 3rd,or if filled at special election,within 21 days after the election.
• United States Representative-I will be an inhabitant of this state when elected and I will be at least 25 years old and a citizen of the United States
for not less than seven years on the next January 3rd,or if filled at special election,within 21 days after the election.
• Governor or Lieutenant Governor-I will be at least 25 years old on the first Monday of the next January and a resident of Minnesota for not less
than one year on election day.I am filing jointly with
• Supreme Court Justice,Court of Appeals Judge,District Court Judge,or County Attorney-I am learned in the law and licensed to practice
law in Minnesota.My Minnesota attorney license number is
• State Senator or State Representative-I will be a resident of Minnesota not less than one year and of this district for six months on the day of the
general or special election.
• County Sheriff-I am a licensed peace officer in Minnesota.My Board of Peace Officer Standards and Training license number is
• School Boar r-I have not been convicted of an offense for which registration is required under Minnesota Statutes,section 243.166.
County unici chool District,or Special District Office-I meet any other qualifications for that office prescribed by law.
Subscribed and sworn before me this
idate Signature
dk of
(0) -7 — DEBRA A.SKOGEN ut
Date Notaryp�Mind o Notary public or other officer em veered to
uy� take and certify acknowledgments.
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Rev.4-06
white copy—Filing Officer yellow copy—CFPD Board goldenrod copy—Candidate pink copy—Public Information
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City of Fridley Nomination Petition
CTIYOF
FR[DL.EY
We, the undersigned,registered voters of the City of Fridley,hereby nominate -TAh.E,5 T Sr P—
whosX residence is 6131 -5�— SJi2 IVE- for the office of -.N
(vao,-t m&v26P,A4,enT to be voted for at the election to be held on the I day of
AjoyEpa L3c R , 2006; 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
Q persons to be elected thereto.
Date: Prinled Name and Signature Address
p i�� i 3- .� T
13- off ,
Ect WhK ctc
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01 06
l—/3-o
-Sr.jwe:5 4 r C- ,being duly swo , 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."
l
I wish by name to appear on the ballot exactly as follows:
Ulm S4c X
(Please Print Name)
This petition, if found insufficient bhe ity Clerk, shall be returned to
�ame5 Sqceke at b 6 S 0- d 15 , F�idley, Minpjesota. I
hereby indicate my willingness to accept the office of Ou !hem&,z 4Ro I if duly
elected thereto.
f
(Signature of No inee)
SubscrZP—ubli'c)nd sworn &orme this��day of , 2006.
i
(Notary
;DEBR:AA.SKOGEN blb-MinneaEagies.w�:. to
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City of Fridley Nomination Petition
M%
We,the undersigned,registered voters the City of Fridley,hereby nominate �.Iri.h,05%S4 e t 1`e-
whose residence.is 1 131 5 ills , for the office of
O6u tw+l wo4e,- 404A20 I , to be voted for at the election to be held on the 7 day of
Ap u e w Ae r, 2006; 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.
�jiimeDate: renand ignature� Address
=3 ��-�' ' y -s--f
-�.r--A /%/��'Z'%
W, 75S
�—3 ° ��� � �' co��� six � �►�
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:
sge �
(Please Print Name)
This petition, if found insufficient by 1it�e City Clerk shall be returned to
'lanes S4c-Reat lol _ Sft 4 i� , Fr�'dley, Minnesota. I
hereby indicate my willingness to accept the office ofOOQ if duly
elected thereto.
� CPQ
14k LX,
(Signature of ominee)
Subscribed and swo before me this/7 day of 2006.
l
(Notary Public)
D M A.SKOGEN
Npftwesm
gn 18010
Wor
1., Ao�%.
City of Fridley
Public Disclosure Statement
By City Council Members or City Council Candidates
Name: ,giy/�s % 619C--FA<F Date 0 7 //,7 �D �
Position Title: ���,���, 1 t- h r C.vr592o -L
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 Personal Interest
Partnership, Etc. 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:
Non-Homestead Real Property Address
` &CEAsei3 AP-&n1*T o mG — aw 02 SAtIEI
470 NE-
(use
E(use additional paper if necessary)
Disclosure form Page 2
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 Real Property Address
e ':;?--
(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.
r�
Signature)
Note: This statement must be filed annually or when there is a material change in
financial interest or in position held.