Nee, William J - Mayor FORM 11(WEVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
State of_M/,innesota fs No.�
County of !Yr'� �
(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 11 - 4'k2
My post office address is: WC,4 �. r
�" ��✓ (Zip) S-s-h1,3 cZ
D' )) K/e
T,� (Sign name as wanted on ballot)
Subscribed ands ■ day of �U 19 �
CLYDE V. Mt3RAVFTZ
IWAV rMIC-:1M�isoTA
ANOKA COUNTY own),(City) Clerk—N terry Public
SEAL 19MyCewmktWrExPim*J*n-07,1988 D reQ County,Minn.
N
NOMINATION PETITION s
We, the Nundersigned, electors of the City of Fridley, hereby nominate
Gl 0havt 1T et whose residence is a« LoE5,aN Pays► ' /�a,y� ^/, �
for the office of M a v p to be voted for at the
election to be held on the �*ay of , 1983 ; and we
individually certify that we are qualifies electors and that we have not signed more
nomination petitions of candidates for this office than there are persons to be
elected thereto.
me Street and Number
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, being duly sworn, deposes and says that s/he
Name of Nominee
is the circulator of the foregoing petition paper containing signatures, and that
the signatures appended thereto were made in his/her presence and are the genuine
signatures of the persons whose names they purport to be.
I wish my name to appear on the ballot exactly as follows:
i
Please Print
(Signa tur f Nominee
Subs ribe and sworn to before me this - day
of 19 73 -
WALTER J. MULCAHY
NOTARY PUBLIC-MINNESOTA
tary PublRAMSEY COUNTY
"MY Commission Expires Oct.o7,19B8 y
NVVWWWVVVVVVVWVVVVVWWWWVYWO
This petition, if found insufficient by the City Clerk, shall be returned to
tyiIIla P at Number al9 (06ax P"k Waj Street.
I hereby indicate my willingness to accept the office of
if duly elected thereto.
Signat of Nominee)
CC1280 re
CITY Of fRIDLEY
+ PUBLIC MSCLOSURE STATEi1EiIT BY CITY COU;lCIL OR COM-MI. CANDIDATES
NAr,r 103
DATE
TO: CITY CLERK
In MfOrN3:;Ce With Section 30 of the City Cede, I hereby make the following
declaratirsas regar6r:9 my financial and personal interests:
Y
1 . Names of all business corporations, partnership�s, other business enterprises,
or governmenk.-al agencies doing "buSiness with the City of Fridley or located
Within the City of Fridley:
a. With which I have a financial interest.
(As !sed in Chapter 30, the term financial interest shall be deemed
V, include rnmership of more than 10Z of: The Outstanding stock in
a ccrpurat-iun, an interest in a partnership, proprietorship, or
other business enti;;y, or an interest in real property. Financial
interest shall apply to real or ricrsonal properties owned by the
person malting the disclosure and by said person's spouse. )
b. With which I have a personal interest. �
(Rs used in Chapter 30, the term personal interest shall be deemed
to app'l-, l en'v r a ;person reaUi red to Hake a di scl osJre under this
cede of ethics shall be associated with a business as an eirrployee,
officer, director-, trustee, partner, advisor on consultant. ) '
irAi•"L (;F--G?iSTPjc"-S;;, — - - FIiIANCIAL �E, ��014;;1-
PARTNERSHIPS, ETC. ADDRESS 114TEREST IN-1EREST
(Use additional raper if' necessary. )
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' 2. A list of the non-homestead real property located within the City of Fridley
in which I currently have a financial interest:
NOF -1,10MFSTE/ID TEAL PROPERTY
ADDRESS '
(Use additional paper if necessary. )
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3. A list of the non-homestead real property located within the City of Fridley
' in which I had. a Financial interest within the preceding three years.
h0N-1.0MESTLAD PE/!L PR0PERT Y
ADDRESS
(Use additional paper if necessary. )
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. 4. A list of the 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 otlfer 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
NIVIES PARINERSHIPS, 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 30 of the City Code. SignaV'sa
Note: This statement must be filed annually or when thereaterial change
in financial interest, or in position held.
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