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Commissioners City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: Wc.17,tILe- -Dl �uDate J" Position Title: Cvm6ic - r-R "m,.' e-,e— In conformance with Section 5.05 of the Fridley 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 tenn financial interest shall be deemed to include ownership of more than 1011/6 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 one 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 c ated v.ri*h a business as an employee,officer,diredor,trustee,partner, advisor or consultant.) Name of Business, Address Financial Interest Personal Interest Partnership,Etc. (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: Non-Homestead Real Property Address (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. tore) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. Wd 6Z:6£:£IrWZ/LC/L AeQ V :abed 000L8LZZ96:Woi= City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: &I,VLe-- Date l Position Title: In conformance with Section 5.05 of the Fridley 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 one 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, Address Financiai.kiteiest Personal Interest Partnership,Etc. ' ! l (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: Non-Homestead Real Property Address ,`, 6�� (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: _ C�� "0.7. Z2 /./ Date Position Title: du,&(s In conformance with Section 5.05 of the Fridley 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 teal or personal properties owned by one person malting 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) Nz , 7777Address:' FinanetalInterest kexsani�llnterest Pazr�rs ,Etc. �jo�va (use additional paper if necessary) 2.. A list ofthe non-homestead real property located within the City of tidley in which I currently have a financial interest: Non=Homestead Ileal Properly Acls (use additional paper,if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5..05 of the Fridley City Code. --_ (Signature) Note: I his statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest white on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: V-0-1 ( e, , Date 2/Z 7 Position Title: In conformance with Section 5.05 of the Fridley 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 one 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, Address Financial Jnterest Personal Interest Partnershi ,,Etc. 11 rOQKRo 61 Lox 32_8LS r, 1k (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: Non-Homestead Reil Propel Address (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Sign e) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: el_ Date I Iti Position Title: ( ;cs, , f ckz L� In conformance with Section 5.05 of the Fridley 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 one 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©f Business; Address Financial Interest Personal Interest Partnership,Etc. (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: Non-Homestead Iteal.Property Address (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. i ature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: 00/i n 0 V l iDate /// c / c/ Position Title: ('he,,- _ J' In conformance with Section 5.05 of the Fridley 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 one 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.) Dame of Business, Address Financial Interest Personal Interest Iiartnershi ,Etc. (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: -:x=Nori-�Home4ead Real Prpperty Address P/VAi r (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. J (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: a ��� ✓c� ,�c=�� Date i Position Title: 276 //' cls-, C U C, C'/j k, r In conformance with Section 5.05 of the Fridley 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 one 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, Address Financial Interest `Personal Interest Paowrshi ,Etc. (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: Nor-Homestead Real Prop #y Address,:; (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: o�U�C. Date i 17 r Position Title: - (,� vAit In conformance with Section 5.05 of the Fridley 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 one 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, Address Financial Interest Personal Interest Partnership,Etc. 4 Gatti. i, (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: Non-Homestead Real Property Address (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pur t S h Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies J I�L>A7-V\,-M � L,vt Date Name: V 1 -- — Position Title: >4lqR C-oyr/Yl�, ssa6vE,4 CART�Q Cam�iss>a,y ME.�.r, .� In conformance with Section 5.05 of the Fridley 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 one 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, Address; 1~inanc al Interest Personal Interestz Partnershi ,Etc. ©N� (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: Non-Homestead Real Property.Address (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. �e (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: 1,AWAe u 4e CC-W W el" Date l / Position Title: J jRA G o,n,•t ls,a velL In conformance with Section 5.05 of the Fridley 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 one 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 mf Business, Address Financial Interest Personal Interest Partnership,Etc. VII14 kos4 $21 a. gT; 90^i r2 0a. 1067. V61'r,h cur As. L49 Al A l.-'y low (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: Non-Homestead Rel Property Address Na,✓t= (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. From:7635747371 Page: 1/1 Date: 1/16/2014 4:26:40 PM City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: 7vf. volt/ ,O.,.4 C 1<'L. c.fv Date / 1 G -.2 o i y Position Tide: In conformance with Section 5.05 of the.Fridley City Code,I hereby make the£oltowimg declarations regarding MY financial and Personal interests: I. 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 fuancW 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 one pexson matting the disclosure and b said person's spouse.) Y 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 ofsincss, Address . P All) ,w7 •c (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: -Noir- es :. 1 lmpetty Adder (useadditional paper i£necessary) I do swear(or affm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappoinhuent to au advisory comm uce or mates W changes in frnaw'W interest while on an advisory con m uce. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: Date 1 2-7 14 Position Title: PA i In confon-nance tivith Section 5.05 of the Fridley 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 ten-n 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 properly. Financial interest shall apply to real or personal properties owned by one person making the disclosure and by said person's spouse.) b) With which I have a personal interest. (As used in Chapter 5, the ten'n 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.) [- -'-Ka�e-�f-Business,---T --Aij7d-ress'-- Financial Interest Personal Interest- Partnership, Etc. (use additional paper if necessary) 2. A list of the non-homestead real properly located within the City of Fridley in which I currently have a financial interest". Non-Homestead Real Property Address (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridlc,,,City Code. ignaturc) \i 'ote hkmatemem muSi be filcil upon an)(mmilem Of reaPP04111111C111 1k)ars ad\Isol-, courmilice or 111alcrial chan2C, in finam,ml mtercsi a hilc on an advisor\ committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: GE fT Ce,►o-- G—" b , i Date Position Title: # x c e— c h a i r In conformance with Section 5.05 of the Fridley 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 one 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, Address Financial Interest Personal Interest Partnership,Etc, (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: Nc -Homestead Rest Proper y'Atldres�# (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. OL ell (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: llp,. itT-'--- Date / 7 -O"K Position Title: pt3,e K �'c c a.n<•-+ In conformance with Section 5.05 of the Fridley 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 one 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 ofBusiness, Address': Financsa. Interest Pesonai Interest )?artnershr`;Etc. (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: .. Non=Homestead Real,Property Address ZA (use additional paper if necessary) 1 do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: 57 � Cf� 2/i1. 1 Date Olt,4 Z gZc� Position Title: In conformance with Section 5.05 of the Fridley 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 one 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.) i Name of Business, Address " Financial Interest' Personal Interest j Partnership;Etc. . (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: Non-Homestead Real Property Address " (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Sectio 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: �c/` �ti+i5 Date 41 Position Title: u.� i,c/WY Q � / �.fN,J/•c�G In conformance with Section 5.05 of the Fridley 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 one 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, Address Financial Ingest Personal Interest P 'hip,Etc. (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: Non-Homstead'RealtPro peiyAddss (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. From:,unknown Page: 1/1 Date:2/3/2014 3:58:31 PM y City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: Date I;Pj Position Title: _/ 400,�idi k QrA�!'1ONLIq In conformance with Section 5.05 of the Fridley City Code,I hereby make the following declarations regarding my finmacial and personal interests: 1. Names of all business corMations,partna*ps,other business enteaprises,or govern Cntal agencies doing business with the City of Fridley or looted within the City of Fridley. a) With which I have a£mamcial fitt+ t. (As used in Chapter 5,the team.financial intet shall be deemed to include ownership of _ J — more than 10%of the outstaiiding stock in a corporation,an intre:st is a partnashiP, proprietorabip,or other business entity,or an interest in real property. Financial interest. shall apply to real or personal properties owned by one person making the disclosure and by said person's spouse.) b) With which I have a penonal interest. (As used in Chapter 5,the terns personal interest shall be deemed to apply wherwer 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 oonsultant.) (use additional paper if necessary) 2. A list of the non homestead real property located within the City of Fridley in which 1 currently have a financial interest - - -. -- _- - AWA 704 .H/G At r i (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Signature) Note: This saatenmcut must be filed upas appointment or reappomimenrt to an advisory committee or material chooses in financial interest while on an advisory commidw. City of Fridley Public Disclosure Statement P y M be o viso ry Bodies f Name: Date Position Title: In conformance with Section 5.05 of the Fridley 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 one 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, Address Financial Interest Personal Interest Partnership,Etc. (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: Non-Homestead Real Property Address L (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement purspfrnt to ection 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. From: Deb Skogen Del-Skogermt fndleymn.gov Subject: Public Disclosure Forms Date: January 7,2014 at 7:58 AM To: damar280@aol.com,gpackerman@comcast.net,barrett@fridley.k12.mn.us,mike.heintz@ unitedsurfprep.com, tim.solberg@genmills.com Cc: Sue Johnson fridlevnin gov,Jack Kirk Jack.Klik c-fnaieytnrt Fridley City Code, Chapter 5, requires all Advisory Commission members to submit a "Public Disclosure Statement." Each Commissioner shall file the disclosure 30 days from appointment and annually thereafter. The form must be completed and returned, even if there is nothing to declare. Please complete the attached form and return to me by Friday, January 24th. If you have any questions or concerns, please let me know. Thanks for your help in this matter. Debra A. Skogen, MMC City Clerk, City of Fridley 6431 University Avenue NE Fridley, MN 55432 763-572-3523 deb.skogen@fridleymn.gov Fax: 763-502-4981 City of Fridley Public Disclosure Statement By Members of Advisory Bodies Name: 1)64AI 1 Date I Position Title: c� •^t�'f S Si a;V�� , 7- L�}, �c In conformance with Section 5.05 of the Fridley 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 one 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 pfBusiness, Addresinanci a Inttrest Personalnterst Part erslu ,tic. Al D N (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: Irl9o.=Homeat6 R 1'Prerty ddress Al d Jill% (use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the Fridley City Code. (Signature) Note: This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee.