Barnette, Bob - Ward 1 FORM 11(REVISED 1980).MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT IOF CANDIDATE & RECEIPT FOR FILING
Mate of Minnesota
TOWN OR CITY ELECTIONS 4
- �
County of.-
IS. No.
OKA) GT? L
(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 filedforany other office at this election.
I am seeking election to the office of
I reside in the city or township of R t •t 4.�f
My post office address is: S"'Y1 91 C.C- P-9 G k-- k3,A ✓D
tJV1 A
(Sign name as waicjfg pn ballot)
Subscribed and sworn to before me this day of , 19_kt1_
(Town) (City) Clerk-Notary Public
SEAL —County,Minn.
NOMTEmTON PETITION
We, the undersigned, registered voters of the City of Fridl"
hereby noriiinate ++ OBEt-r &4ewErrE j, whose residence is
S yWRICE C.KEEK 81.va , for the office of
FIRST WARD COyi✓c!t/h A N , to be voted for at
the election to be held on the ' 3 2D day of No ✓ , 19 ?7;
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.
.; T AND R
rim
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las-0
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2-10 - -7 Sr-
A015ber EWAM''ffE , being duly sworn, deposes and says, "I
(Name of 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:
809 --8AAA1E7re
(Please Print)
f8ignatuie of Nominee)
Subscri ed and sworn to before me this ,..__day AAAAuv v*A.
Of , 19-e Z. 5,� CAROLYN M. OLSON
NOTARY PUBLIC- MINNESOTA
ANOKA COUNTY 5
(Notary Public) MyCommission Expires Feb.20,1991 7
KMVVVVVVVv✓vvVv\ •
This petition, if found insufficient by the City Clerk, shall be returned
to _8,t3 , at Number -s7/1 6� c'Ic'ci?;< r3 Street.
I hereby indicate my willingness to accept the office of
eon c ik'e
if duly elected thereto.
L2 � 1�-A - 2
(Si Nominee)
ture of Nom
3/0/1/9
,1 'ION PETITION _.
We, the"-undersigned, registered voters of the City of Fridlej,
hereby nominate , whose residence is
, for the office of
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 STREET AND NUMBER
xvjlljx"f J
being duly sworn, deposes and says, "I
(Name of 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-b&U-et � v �� ^Maws•
(Please Print
( gnatu a of Nominee)
Subscr' and sworn to before me this _„qday �,,,,,,,,�,�, MAA
� CAROLYN M.OLSON
rh NOTARY PUBLIC - MINNESOTA
ANOKA COUNTY
tary Public) OYQOmmissionExpires Feb.20,1991
Va.
This petition, if found insufficient by the City Clerk, shall be returned
to 806 AA ,1V&--rC , at Number -51-// k c-a c',L3&arc- A 4� v,-.9 Street.
I hereby indicate my willingness to accept the office of
`'`'vc ' `-MAN if duly elected thereto.
(Sigrfature of Nominee)
3/0/1/9
CITY OF FRIDLEY
PUBLIC,DISCLOSURE STATEMV BY CITY COUNCIL OR COUNCIL CANDILIAM
NAIL �.B �C�/IPl1��TTt= DATE
TO: CITY CLERK
In conformance with Ser. 5. 0 4 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.)
NAM OF BUSINESS FINANCIAL PERSCM
PARTNERSHIP, ETC. ADDRESS IIVTERm INTEREST
(Use additional paper if necessary.)
20- A list of the non-homestead real property located within the City of
Fridley in which I currently have a financial interest:
NODI-SCHEST'SAD REAL Pte' ADDRESS
/V10 1111�5-
(Use additional paper if necessary.)
- s
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) :yearrs:
NON-BOMESTEAD REAL PROSY ADCMS
(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 CORP RMIONS
NAMES PAMIE MIPS, OR OMM BUSINESS ENTERPRISES
NO Alt
(Use additional paper if necessary.,)
I do swear (or affirm) that this repcwt is a full and true statement
pursuant to Sec: 5. 04 of the City
I
(Signature)
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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