Loading...
McCarty, Jack P - Ward 3 FORM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS AFFIDAVIT OF CANDIDATE & RECEIPT---FOR FILING TOWN OR CITY EIECTIQNN � State of Minnesota JJ ' No.C s21L/ County of F19 6- (Print name as wanted on ballot) swear(or affirm)that I am qualified cinder 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 1 I reside in the city or township of 6 S;4L bi 5±d �• My post office address is: I/--fs i' 3 (,CJc , -w C. (Zi .5 SUr'Z c (Sign name as nted on ballot) Subscribed and sworn to before me this d y of , 19 ( wn),(City)Clerk—Notary Public SEAL County,Minn. _ r MINMWN PETITION? We, the undersigned, registered voters of the City of°.Fridley, hereby nominate StqE-C C(fAg! ' j , whose residence is CgS��Z WA,2 WA, N ` c • for the office of to be voted for at the election to be held on the �.0 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. MEASTREET AND NUMBER 1x790 ©. .a/ &etz° '�V�v r. bL LAXV ffj L7 6.( b� 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: (Please Pr' c/f- Signature of ) Subscrbed and sworn to before me this day of , 19A7. #NOTARY BRADLEY D HOCH PUBLIC MNNESOTA HEMEPINCOUNTY ( ry lic) Commi"an-Expuea May&1 Y This .petition, if found insufficient by the City Clerk, shall be returned to��/Y�l� /4l eC , at Number ff _ Street. I hereby indicate my w' ingress to accept the office of c�� S � if duly elected thereto. (Signature of ) 0/1/9 ?°�/ /73 I �" r NOMINATION PETITION We, the undersigned, register voters of the City of-Fridley, hereby nominate 1►'V" �-� , whose residence is for the office of Cru tiO4 , 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. NAM STREET AND NUMBER �- B 75- 9'6- r 1V. 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 xactl —as follows: � Mc (Please Prin ignature of Nominee)bscSur' d and sworn to before me s *2y " of 8, 19 c�� 1. 1. BRADLEY D �ESOTA ppTAR 4@ �COUNTY° (NO ry Publ c) My ConrmissioR ExP�res May 1 2his if found insufficient by the City Clerk, shall be returned to i r at Number t — C�Z U Street. I hereby indicate my w' lingness to accept the office of � 0 if duly elected thereto. (Si ture of (3/0)/ /9 CITY OF FRIDLEY PUBLIC D;SC1MURE STATmw BY CITY QOUN-IL cR,* O mm CAr mATFS NAM � DATE TO: CITY CLERK In conformance with Sec. 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.) NAME OF BUSINESS FINANCIAL PERSONAL PAPMOMIPt ETC. ADERESS INTEREST INTEREST (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-HOMESTEAD REAL PROPERTY ADDRESS (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 interebt withih-the preceding three (3) years: NON-HOMESTEAD REAL PROPERTY ADDRESS (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.) NMURE OF BUSINESS - OF ALL CORPORATIONS PA TIPS, OR OMM BUSINESS MMMMM ff 0__W_ (Use additional paper if necessary..) I do swear (or affirm) that this report is full a true s tement pursuant to See-., 5.04 of the City Code. (S tore Note: This statement must be filed annlly or when there is a material change in financial interest or po tion held.