David Anderson, Civil Attorney
City of Fridley
Public Disclosure Statement
By the City Attorney
Name: Date
Pursuant to Section 5.07 of the Fridley City Code, I hereby make the following declarations regarding my
financial and personal interests:
1. Names of all business corporations, governmental agencies, companies, firms or partnerships, or other
business enterprises doing business with the City of Fridley or located within the City of Fridley in which I
have any financial interest, except that clients of City Attorney’s private law practice shall be excluded
from the list, provided that no other business relationship except that of attorney/client exists.
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.
Name of Business, AddressFinancial 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 5.07 of the Fridley City
Code.
_____________________________________________ ___________________________
Signature Date
This statement must be filed upon appointment or reappointment to an advisory committee or material
changes in financial interest while on an advisory committee. Please submit a signed Public Disclosure Form
to the City Clerk’s Office. Thank you.