Barnette, Robert - Council at Large FORM 11(REVISED 1980)MILLER-DAVIS CO.,M11 NEAPOLIS
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AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
State of Minnesota TOWN OR CITY ELECTIONS
SS. No.—
County of— 0 / 0--a-0I, 2�. R o 6 co 7 4� ( 6/e AJe 7 7-e
(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
My post office address is:
(Zip)
Ro(3e-0 T ,BAR 4�,fTTPESign name as wanted on ballot)
Subscribed and sworn to before me this y of (IJ , 19E
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SHIRLEY A. NAAPALA C,
ai NOTARY PUBLIC- MINNESOTA Own),( i ) Clerk—Notar5 Public
SEAL 1 ANOKA COUNTY
My Commission Expires May 28,19C` County, Minn.
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Affidavit of Candidate
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Filed in the office of the
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Countyof------------------------------------------
Minnesota, this-----------------------------day of
---- ---------------------------.A. D. 19------
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MILLER-DAVIS CO.. MINNEAPOLIS
NOMINATION PETITION
We, the undersigned, electors of the City of Fridley, hereby nominate
/ �BF�T • L3 h/ ii whose residence is ,(// R,�ce5' eXErt. 'el-VOr ,
for the office of to be voted for at the
election to be held on the d day of �,-y�,Z,L 19-; and we
individually certify that we are qualified electors and that we have not signed more
nomination petitions of candidates for this office than there are persons to be
elected thereto.
Name Street and Number
all I
Ld2ffwn rye
�jy-r�� ��.�� `' may/ •�..�� �����,� � , .
Roe_ r .0• 6AeA15-71�,C being duly sworn, deposes and says that -s/he
Name of Nominee T---_
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:
Please Print
i
Sig ature of Nominee
SubscriPed nd sworn to befo me this zoo '6ay
of 19 .
� v�nnnnnnnnx:
SHIRLEY A. HAAPALA ?
NOTARY PUBLIC- MINNESOTA
Notary Ubl 1 MyCommission ExpiresPo ay2C,IC,&b
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This petition, if found insufficient by the City Clerk, shall be returned to
�496A,er /_ 6ARAye�71'1—r at Number 5-11t elc ckee& Street.
I hereby indicate my willingness to accept the office of
if duly elected thereto.
Sig ture of Nominee)
CC1280
1 p
NOMINATION PETITION
We, the undersigned, electors of the City of Fridley, hereby nominate
,&&C-,e - Z— AAeA16712 whose residence i s 5�5% '.ICE' 6eE�,t ,8c-yo, ,
'for the office of Coy,,vciL m.9ry - A - to be voted for at the
election to be held on the day of and we
individually certify that we are qualified electors and that we have not signed more
nomination petitions of candidates for this office than there are persons to be
elected thereto.
Name Street and Number
l v� �. (�g-_ �� 1-
�X 91
(��Z60 tv-
Rad,5�e T 6, .8A&1�Tib being duly sworn, deposes and says that s/he _
Name of- Nomi nee -- _--
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:
lPO&,e 7- C , leAeA%Tl�
Please Print
Sig ature of Nominee
Subsc ' ed and sworn to befQ�re me thisoW/& day MA,�Y
Of s 19 st x SHIRLEY A. HAAPALA
NOTARY PUBLIC— MINNESOTA
ANOKA COUNTY
My Commission Expires May 28,1986
Notary Pub is
This petition, if found insufficient by the City Clerk, shall be returned to
I?o,BEe-T L, ,BARAlc-2725- at Number 54// ,q/C—, Se-p'o_ Street.
1 hereby indicate my willingness to accept the office of C.owc;e-m,41y -A-r-J-AsI!GLc
if duly elect d thereto.
Sign ture of Nominee)
CC1280
CITY OF FRIDLEY
PUBLIC DISCLOSURE STATEMENT BY CITY COUNCIL OR COUNCIL CANDIDATES
NAME P"— /S'R.?
DATE
TO: CITY CLERK
In conformance with Section 30 of the 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 30, 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 the
person making the disclosure and by said person's spouse.)
b. With which I have a personal interest.
(As used in Chapter 30, 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 on consultant. )
NAME OF BUSINESS, FINANCIAL PERSONAL
PARTNERSHIPS, ETC. ADDRESS INTEREST INTEREST
(Use additional paper 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:
NON-HOMESTEAD REAL 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.
NON-HOMESTEAD REAL PROPERTY
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 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 OFBUSINESS - 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 30 of the City Code. gnature
Note: This statement must be filed annually or when there is a material change
in financial interest, or in position held.
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