Goodspeed, Biran - Ward 1 FORM 11(REVISED 1980)MILLER-DAV1S CO.,MINNEAPOLIS _'•
A AFFIDAVIT OF CANDIDATE & RECEIPT FOR FI
State of Mi nesota
TOWN OR CITY ELECTIONS LING
�
County of_ SS. No.
I, r4 ) C® v p s 6-'� � 0
(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 ofW C,,� y
I reside in the city or township of SLC
My post office address is: �l
(Zip)d` �! 'C�C3-Z-
Subscribed and sworn to before me this 7 (Sign name s wanted on ballot)
x day of 1
SHIRLEY A, `ALA
HAAPALA � �
NOTARY PUBLIC-WN,NESOTA (Town ,( ity) Clerk—No ary Public
SEAL AIYOKA CoutAly �� ��
�0q� �� County, Minn.
N0MIyATION PETITION
We, the undersigned, electors of the City of Fridley, hereby nominate
Bmqd GWLPPeCL whose residence is `131 IL'k,, C.r
I
for the office of ( CII "rfj to be voted for at the
election to be held on the day of &—,,9Leaikr7 , 19-14; and we 1
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 f �
76 750 Kenn as�o n 01^/'✓Q-..
! o (tee, "LIT
g
,f
73/
�—Z-42 Z2
� fc
dej
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
of the persons whose names they purport to be.
I wish my name to appear on the ballot exactly asollows: -
Please Print
Signa4rtrf 4oion-ee
Subscr' ed and sworn to before a this /%e�(day
Of , 19
/l �{
° -
coUNMryrDNRLEY MINNE
SUTA
NOAAr gives Y6,199
8K
si0a(Notary Publ c
his petition, if found insufficient by the City C1 rk, shall be repurned to
Al t Number Street.
I hereby indicate my willingness to accept the office of
�,(JGcIL�,Q if duly elected thereto.
Signature of N minee)
CC1280
NOMINATION PETITION '
We, the undersigned, electors of the City of Fridley, hereby nominatee/ -7-
81-j'Qa_ whose residence is �� /C2�_-CcC;eK 1 �Y
for the office of �/ V ( V"a r� L to be voted for at the
election to be held on the day of No V 193-�-; 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
730
t
Y
r ls'ooj5 epi being duly sworn, deposes and says that s/he
Name of Nomi e
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
- ----s-�res_af_the persons whose names they purport to be.
I wish my name to appear on the ballot exactly as follows:
3rlay-\ G00J'5eed ._
Please Pri
J1,GG[iV��
Signature of Nominee
Subscribed and sworn to before me this Z22y day
Of , 19 '7,41. .A# 4MAAAAAAAAAMAAA"V11tAkMMIr
SHIRLEY A. HAAPALA
NOTARY PUBLIC- MINNESOTA
�- ANOKA COUNTY
Notary P 11C MyCommissionExpires May28,1986
f
Thispetitio if found insufficient by the City lerk, shall be returned to
at Number tedStreet.
I hereby indicate my willingness to accept the office of&'�
if duly elected thereto.
Signature of Nomin e)
CC1280
CITY OF FRID`EY
• 1111i:LIC M SCLOSURC STATEMENT 6Y CITY COWICIL OR C011ML CANDIDATES
117NAL
DATE
TO: CITY CLERK
In conforvi3nce witn Section 30 of the City Cada, I hereby make the follot•ring
declarat-ioas reial-Oirg my financial and personal interests:
1. Flares of all business corporations, partnerships, other business enterprises,
or governmc.nt&l agencies doing business with the City of Fridley or located
within the City of Fridley:
a. b;ith v:h►c.h I have a financial interest.
(A:; u.sed in Chapter 30, the ter�ii financial interest shall be deemed
to include ownership of more than 10' of: The outstanding stock in
a corporat-iun, an interest in a partnership, proprietorship, or
other business entity, or an interest in real property. Financial
ire- rest shall apply to real or personal properties ormed by the
person making the disclosure and by said person's spouse. )
I
b. 'With ;;Lich I have a personal interest.
(As used in Chapter ::0, the term personal interest shall be deemed
to appl,v -hey :?v r a ,person refgM reu to Hake a di scl os;:rc under this
- code of ethics shall be associated with a business as an ei�iployee,
officer, director, trustee, partner, advisor on consultant. )
FlNA —IV-FI)C0N i-
PARTP,ERlHiPS, E i C. AVRESS 114TEREST Ii:i EREST
n b,-V-% P__
(Use additional paper if' necessary. ) r
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2. A list of the non-homestead real property located within the City of Fridley
in ahich•I currently have a financial interest:
NON-110• EMAD REAL PROPE ZTY
ADDRESS
(Use additional paper if necessary. )
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I
3. A list of the non-homesteart real property located within the City of Fridley
' in which, I had. a Financial interest within the preceding three years.
NOP!-1110MES T LAD REAL P, E:cTI'
ADDRESS
(Use additional paper if necessary. )
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4. A list of the names, and nature of business, of all corporations ,
partnersiripsi or other business enterprises with which I have a financial
interest and in which I krnow 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 Or BUSINESS - OF ALL C RPOIZATIO;JS
N/VES PARTNERSHIPS, OR OTHER BUSINESS '11TERPRISES
i —_
(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. Signature
Note: This statement must be filed annually or when there is a materia change
in financial interest, or in position held.
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