Dahl, Deborah City of Fridley
Public Disclosure Statement
By Top
�Level
City Employees G�
Name: v" � V I Date
Position Title:
In conformance with Section 5.06 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
(use additional paper if necessary)
3. A list of 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 Enterprises
(Use additional paper if necessary)
I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.06 of the
Fridley City Code.
(Signature)
Note: This statement must be filed annually or when there is a material change in financial interest or in position held.