Korrie Johnson, Acting Finance Director
City of Fridley
Public Disclosure Statement
By Top Level City Employees
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Name: Date
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Position Title:
Pursuant to 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, 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
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(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.
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_____________________________________________ ___________________________
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.