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Varichak, Dolores City of Fridley Public Disclosure Statement By City Council Members or City Council Candidates Name: 'N1 a S \140-i cRr,..t Date '-( /13/LS" Position Title: ,'‘, 0ue;l m4 m bir u34,, In conformance with Section 5.04 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 fmancial 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 1(00I 5TLA V , m 13 i s}) (use additional paper if necessary) 3. A list of the non-homestead real property located within the City of Fridley in which I have had a financial interest within the proceeding three years. Non-Homestead Real Property Address (use additional paper if necessary) 4. 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 5.04 of the Fridley City Code. /-0/01,-,,Lir)- (Signature) Note: This statement must be filed annually or when there is a material change in fmancial interest or in position held.