Fitzpatrick, Ed - Ward 3 FORM 11(REVISED 198�MILLEW-ItAVIS CO.,MINNEAPOLIS ' �4
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AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
State of Minnesota fs No.
County of �Ck/
(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
f My post office address is: oZ °n
Zip)
Sign name as wanted on ballot)
Subscribed and sworn to before me thisday of , 19.F/
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NOMINATION PETITION
We, a undersigned, electors of the City of Fridley, hereby nominate
d�
whose residence is S'Z
for the of ce of �,1 to be voted for at the
election to be held on the day of 192Y_; and we
individually certify that we are qualified Lctors 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
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;fes
N iA
E 3v t�r t- ,,, ,,t , =
�d �' z roc jk being duly sworn, -deposes and says that s/he
Name of No inee
is the circulator of the foregoing petition paper containing signatures, and that
-the signatures appended thereto wcre rte in._h_is!her—p-m—e,'s a and_ are the q_enuine
signatures of the persons whose names they purport to be. -
I wish my name to appear on the ballot exactly as follows:
� �ZPZ f r-/cf<'
Please Print
r
SHIRLEY A. HAAPA
1� NOTARY PUBLIC- MINNESOTA <
d ANOKA COUNTYIM
MyCommiasionExpilssMay28,1986 ture Nominee
V%^V
Subsc 1 ed nd sworn to before me this � ay
of 19 Wy.
U
otary Public)
This tition, if fo nd insufficient by the City er , shall be urned to
at Number �Z , Sweet.
I hereb indicate my willingness to accept the office of '
T
if duly elected thereto.
ignature o ominee)
CC1280
_ CITY Of fRIDLEY
• {'l1i;LIC 1);SCLO'SURE STATEMENT BY CITY COUNlCIL OR COUNCIL CANUIOATES
t
DATE
TO: CITY CLERK
In eonforvii3nce with Section 30 of the City Cede, I hereby make the follo►•;ing
declarat,io;is regarding nay financial and personal interests:
1. Ma-mes 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 a;hic.h I have a financial interest.
(AS Wsed in Chapter 30, the terns 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 entry, or an interest in real property. Financial
int-crest shall apply to real or personal properties owned by the
person malting the disclosure and by said person's spouse. )
b. 'With :rhich I have a personal interest.
(As used in Chapter ::0, the term personal interest shall be deemed
to app -1/ !::;encu;r• a person req Ui red to make a d i scl os;:rc undo- this
Code of ethics shall be associated with a business as an elilpioyee,
officer, director, trustee, partner, advisor on consultant. )
tiAi•'F f;F 6�.isTN S — - - F I I 1 A N C I A L 1�'-,r- 50d11,1_
-PARTNER-SHIPS, ETC. ACDRI SS 114TEREST INTEREST
JV
(Use additional paper if' necessary. )
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2. A lint of the non-homestead real property located within the City of Fridley
in which I currently have a financial interest:
NO(4-t;Uvfff[l D REAL PROPERTY
ADDRESS
(Use additional paper if necessary.)
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3. A list of the non-homestead real property locaied within the City of Fridley
in which I had. a Financial interest within the preceding three years.
NOP;-1I1.0I4ES E/1D f?EF.L PROPERTY
ADDRESS
(Use additional paper if necessary. )
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o
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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. )
I .
r NATURE OF BUSINESS - OF ALL C RPORATIONS
N/VES PARINERSHIPS, OR OTHER QUSINESC.; ENTERPRISES
(Use additional paper if necessarv . )
I do swear (or affirm) that this report ,
is a full and true statement pursuant
to Section 30 of the City Code. ign ture
Note: This statement must be filed annually or whet there is material change
in financial interest, or in position held.
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