Schneider, Dennis Ward 2 FORM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
State of Minnesota TOWN OR CITY ELECTIONS
..
County of A-10 K yq SS. No.
I, Q E 41 n)t S ' 4 S Ctyt A)C_t b£ /2
(Print name as wanted on ballot)
swear(or affirm) that I am qualified under the Constitution and Laws of the United States and State of Minne-
sota to seek the elective public office indicated below. I am a qualified voter in the subdivision where I seek
election. I will be 21 years of age or more on assuming office. I will be a resident of my election district for at
least 30 days by election day. I have not filed for any other office at this election.
I am seeking election to the office of I /f. VyA £yy Y3 4)
I reside in the city or township of_ Zy, 0,P: t- t 119 e.-
MY post office address is: 4
(Zip) 6zg�e�2-
(Sign name as wanted on ballot)
Subscribed and sworn to before me this 14--4- day of , 191
( wn) (City) Clerk—Notary Public
SEAL __[mac✓ County, Minn.
NOKII_NATION PETITION
we, the undersigned, registered voters of the City of Fridley,
hereby nominate Dann ih L . !!�--A A e-j L , whose residence is
0%40 :5t iAson 13LA. , for the office of
W4J ;Z- 1,oLIv4,l m-em r , to be voted for at
the election to be held on the -5 Ah day of l�i�v , 19 51 ;
and we individually certify that we are registered voters and that we
have not signed more nomination petitions of candidates for this office
than there are persons to be elected thereto.
AND M2M
(00� iM�rw�F.rn ►�
IUF
PeSc kie r , being duly sworn, deposes and says, "I
(Name of Circulator)
am the circulator of the foregoing petition paper containing signatures,
and that the signatures appended thereto were made in my presence and are
the genuine signatures of the persons whose names they purport to be."
I wish my name to appear on the ballot exactly as follows:
(Please Priw-
(Signature of Nominee)
Subscribed,pnd sworn to beforeis
Of lop �" 0
t
d;azie—Pee - gAfers S
sr ,r.•K1 NOTARY PUBLIC—
�
;.: ANOKA COUNTY
(Notary Public) My commission expires 4.15.44
This petition, if found insufficient by the City Clerk, shall be returned
t0 anis ��/Iyiei'a,vr at Umber h�Q �iiiScRvi ' -
I hereby indicate my willingness to accept the office of
if duly elected thereto.
(Signature of Nominee)
3/0/1/9
K'lMT_N&ION PETITION
we, the undersigned, registered voters of the City of Fridley,
hereby nominate anni-I4 - 541411-a , whose residence is
for the office of
.c.!��r�r 'r , to be voted for at
the election to be held on the th day of Vo✓ , 19 11 ;
and we individually certify that we are registered voters and that we
have not signed more nomination petitions of candidates for this office
than there are persons to be elected thereto.
STREET AND ISR �
0C
) T
/ VVV
being duly sworn, deposes and says, "I
(Name of Circulator)
am the circulator of the foregoing petition paper containing signatures,
and that the signatures appended thereto were made in my presence and are
the genuine signatures of the persons whose names they purport to be."
I wish my name to appear on the ballot exactly as follows:
r
(Please Pr'
(S3gnature of Nominee)
Subsc an sworn to before me th'sS day
of , 19 .
�
dfvzie fee r:IV(ers
..r�,�< .y::� NOTARY pUtIIC—MINNk.G L-e,�4 �
f` ANOKA COUNTY
(Notary/Public)
''� °�1iAY commission axpires d-15-94
This petition, if found insufficient by the City Clerk, shall be returned
to Dzhidts at Ntamber 0119'0 Miivsmn BL,—A street-.
I hereby indicate my willingness to accept the office of
if duly elected thereto.
2 ` Z/-,
G
(Signature of Nominee)
3/0/1/9
CITY OF FRIDLEY
PUBLIC DISCLOSURE STATMOW BY CITY COUNCIL OR 000NCIL CANDIDATES
NAMEf1!5 `�7 r �y ;d ti LATE 7—
TU: CITY CLERK 1
In conformance with Sec: 5 . 04 of the City Code, I hereby make the following
declarations regarding my financial and personal interests:
1. Names of all business corporations, pa
rtnerships, 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 the
person making the disclosure and by said person's spouse.)
b. With which I have a personal interest.
(As used in Chapter 51 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,
offioer, director, trustee, partner, advisor or consultant.)
NAME OF BUSINESS FINANCIAL PERSONAL
PARZ1MMIP ETC. ASS MRIEREST MRI'EREST
(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:
NW-HoblES TAD REAL PRS ADDS
(Use additional paper if necessary.)
3. A list of the norrhomestead real property located within the City of
Fridley in which I had a financial interest within the preceding three
(3) Years:
NM- REAL mnrwVWW ADD S
II
1p Pj
(Use additional paper if necessary.)
4. A list of the names and nature of business of all corporations,
partnerships, or other business enterprises with which I have a
financial interest and in which
having know
a f i amoral interest incove id
red
by this code of ethics
enterprise. (This list shall indicate the name or names of such persons
or persons having such interest in said enterprise.)
MTURE OF BUSINESS - OF ALL MRPORATIONS
NAMES PARTNERSHIPS, OR OMM BUSINESS WE2PRISES
(Use additional paper if necessary.)
I do swear (or affirm) that this report is a full and true statement
pursuant to See. 5.0 4 of the City •
(Signature)
Note: This statement must be filed annually or when there is a material
change in financial interest or in position held.