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Anderson, Bret - Ward 3 C5SHE.Srq g# Office of the Minnesota F''in Cash/Check# Secretary of State Amount$ djo 'L+185$r Affidavit of Candidacy All information on this form is available to the public.Information provided will appear on the Secretary of State's website at www.sos.state.mn.us. Note:If filing for partisan office and not a major party candidate,you must file both an affidavit of candidacy and a nominating petition:"Candidates for any partisan office who do not seek the nomination of a major political party shall be nominated by nominating petition as provided in sections 204B.07 and 204B.08,and. . . shall file an affidavit of candidacy as provided in section 204B.06."(Minn. Stat.section 204B.03). Please print or type. Name(as it will appear on the ballot): �e n clel-Y®'1 Office Sought: G'©r.me/1 /nem &- &%,& 3 District#: For Partisan Office Provide Political Party or Principle: For Judicial Office Provide Name of Incumbent: Legal Residence Address A1- _ Street Address: `�, _ 6­1� L / C City: f J�I"� �� Stater Zip: •�5���� Campaign Contact Information Street Address: 51912 City: State: Zip: Website: Email: Phone Number: ( 7& ) -6-11' 3759 For all offices,I swear(or affirm)that this is my true name or the name by which I am generally known in the community. If filing for a state or local office,I also swear(or affirm)that: • 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 party's most recent precinct caucuses or intend to vote for a majority of that party's candidates at the next general election. If filing for one of the following offices,I also swear(or affirm)that I meet the requirements listed below: • 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 Board Member-I have not been convicted of an offense for which registration is required under Minnesota Statutes,section 243.166. County,Municipal,School District,or Special District Office-I meet any other qualifications for that office prescribed by law. Subscribed and sworn before me this Candidate Signature 'day �d DEBRA A.SKOGEN Date •' No"PubUo-Minnesota Notary pu lic or4otherotticer em-nom-re o INA AM i.�• MYCommWan Etoms Jan 31,2010 take and certify acknowledgments. Rev.4-06 white copy—Filing Officer yellow copy—CFPD Board goldenrod copy—Candidate pink copy—Public Information .C%y of Fridley Page 1 of 2 City of Fridley Nomination Petition We, the undersigned, registered voters of the City of Fridley, hereby nominate l'e-l'w 466 el soi'1 whose residence is 4q1 - ,1-)-'7 �L 6, , for the office of eOan e i'l gem-li& Q nl 3 , to be voted for at the election to be held on the ' day of Lm/P mh. , 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. Date: Printed Name anted,,Si`gnature Address 31 -, -- (2_O i./ Mklt-iaf PP�trio�l/� ' ZY/7 S7'`''/ P4,-e_ .J WA- ,-,O (S (o �i t Cee. lel p pit Paw? 34 dt 4je4SM , 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 naUqe to app ar gn the ballot exactly as follows: (Please Print Name) This petition, if found insufficient by the City Clerk, shall be returned to at , Fridley, http://www.ci.fridley.mn.us/finance/nominatingpetition2006.htm 7/12/2006 City of Fridley Page 2 of 2 MJ'{�nesota. I hereby i dice to my willingness to accept the office of if duly elected thereto. (Signature of Nominee) Subscribed and sworn to before me thisday of '� , 2006. -L� X(Notary Public) , DEBRA A.SKOGEN NoWW Pubft-Minnesota r Mrcomm WWE*M8JM31.zoIo Frequently Asked Questions Back to the Top http://www.ci.fridley.mn.us/finance/nominatingpetition2006.httn 7/12/2006 ri City of Fridley Nomination Petition CT[YOF FRIDLL i We, the undersigned,registered voters of the City of Fridley,hereby nominate l;j; � jd7 c`'rSl whose residence is 5-7-'A ,PL Al' , for the office of i�C'�c tnC ��/ )r/rr/��✓ �rz�� , to be voted for at the election to be held on the day of 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. Date: Printed Name and Signature Address 3 -0&1 11 7m �yC'tV,t'c,l e�facC -//,IV I C�_ b �21af Q_�e 3 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 me to app ar o the ballot exactly as follows: (Please Print Name) This petition, if found insufficient by the City Clerk, shall be returned to at ' Fridley, Minnesota. I hereby indicate my willingness to accept the office of 'OLIA? ` 16116)of U46J' if duly elected thereto. > (Signature of Nominee) Subscribed and sworn to before me this_day of , 2006. (Notary Public) City of Fridley Public Disclosure Statement By City Council Members or City Council Candidates Name: t itl dig deza-e),� Date 7// 7 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 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 (use additional paper if necessary) Disclosure form N.•e 1%4" 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 (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 c c- (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. Ju2, (Signature) Note: This statement must be filed annually or when there is a material change in financial interest or in position held.