Barnette, Robert - Council at Large FORM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT' FOR FILING
Statof Minnesota TOWN OR CITY ELECTIONS
' ISNo.
County of '`�
(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 yt�
I reside in the city or township of
My post office address is:
(Zip)e, y
.��, ✓�
( ign name as wanted on ballot)
Subscribed and sworn to before me this day of 1
SEAL I (T w r —
,(City) CleNotary Public
�' County,Minn.
M \
o YVJ t
r. RnON
f
We, the undersigned, registered voters of the City of Fridley,
hereby nominate /q0ge-47T /-- &A9,0- ✓ETTE' , whose residence is
JTZ/ f's lCE 6?6'ex
for the office of
C001VC C61y?19 n! , to be voted for at
the election to be held on the day of , 19 •
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.
NAME M?ZU AND U14BER
ow
�--
�lc�n
r
i
being duly sworn, deposes and says, "I
(Name 6f Circulator)
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 my-name to appear "on the"ballot exactly as follows: --=- �-- —-
x{08 E2 T /3 f}-k1V6 ZZjE
(Please Prin
(Sigriature of Nominee)
Subscribed and Worn to before me this day
of , 19 A- n%,,\/ n.
HARRIET A.JOHNSON
NOTARY PUBLIC_ MINNESOTA
HENNEPIN COUNTY
(Notary Publl My Commissicr.Egir:;O-t 19,1990
xwwvvwVVVwVVwV,,� VVV" ;V';\'
This petition, if found insufficient by the City Clerk, shall be returned
to 60,6647- 8Ae0V&_7 z_ , at Number S"5il RIC&- Ce- 64tW Street.
I hereby indicate my willingness to accept the office of CDUNC/G-/YJ 1V
Ar 4191?6E if duly elected thereto.
(SigrAture of Nominee)
3/0/1/9
MIM=N PETITION t
We, the undersigned, registered voters of the City of Fridley,
hereby nominate L . 819RWE7 -R , whose residence is
�IGE coeEEIC $4.V' , for the office of
COVAICI GIn Al A T' 4-486 , to be voted for at
the election to be held on the day of , 19
and we individually certify that we are registered voters and that we
have not signed more namination petitions of candidates for this office
than there are persons to be elected thereto.
RIM SITYM AND NLEBER
/f y
being duly sworn, deposes and says, "I
(Name 6f Circulator)
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 my name to appear on-tbe ballot exactly as follows: -
6j418E�2T �,4RNtTr£ I
(Please Pr' !
(Signa re of Nominee)
Subscribed an orn to before me this qday
of
HARRIET A. JOHNSON
`
No
PUBLIC-MINNESOTA
< HENNEPIN COUNTY
(Notary 1c) 6lycommissicnExpiresOct.19,1990
A VVVW'lVVV'JWVVWVVVVVVVVVWWVVVVV r
This petition, if found insufficient by the City Clerk, shall be returned
to 1100,647- 66e!L69Z, at Number I RICA Cc- 6L ✓Q Street.
I hereby indicate my willingness to accept the office of G4 V41c *i4-c
4 A 6 A if duly elected thereto.
(Signat re of Nominee)
3/0/1/9
1
CITY OF FRIDLEY
t PUBLIC DISCLOSURE STATIIMERT BY CITY COUNCIL OR COUNCIL CAMIDATES
NM E �8 -4' L � � DATE 7 - Af J%
210: CITY CLERK
In conformance with Sec. 5 . 04 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 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 the
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 FINANCIAL PERSC NAL
PARINERSHIPr ETC. ADDRESS DTrEREST INTEREST
/1/OA16-
(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:
NM-TiOMESTEAT) RFAL PROPERTY ADDRESS
n/on�E
(Use additional paper if necessary.)
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
(3) years:
NON-HOMESTEAD REAL, PROPERTY ADDS
(Use additional paper if necessary.)
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 OF BUSINESS - OF ALL CORPORATIONS
NAMES PARTNERSHIPS, OR OTHER BUSINESS WrERPRISES
(Use additional paper if necessary.)
I do swear (or affirm) that this report ps a full and true statement
pursuant to Sec. 5. 04 of the City
(Signature)
Note: This statement must be filed annually or when there is a material
change in financial interest or in position held. 1