Velin, Jack - Ward 3 1 FORM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
`
State of Minnesota TOWN OR CITY ELECTIONS
County of
SS. No.
/ a/'C� W(gck)P
(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 41/d i- ('0 U h C i ,p be
I reside in the city or township of /rH � �/
My post office address is: 610 O i o�p TJ
(z >_3Sya/
Subscribed and sworn to before me this �D Sign name as wanted on ballot)
d of
SEAL (Tow ) Caty) Clerk—Notary Public
�� � County, Minn.
r
NOMINATION PETITION
w
We, the undersigned, registered voters of the City of Fridley,
hereby nominate .� , whose residence is
`TJ Y . ✓4M , for the office of i
to be voted for at
the election to be held on the // 4 day of 19
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.
NAME STREET AMID NUMBER
-Y v5
7/x -�
- 91
T ^� .3 37 z0 3.
3--y ^ C '
being duly sworn, deposes and says,7
"I
'(Name of Circulator)
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 Print)
e r
(Signature of Nominee)
S scribed and sworn to before m this day
of / a� , 19
�— s ? l^a SOTA
(Notary ubl C) �� July Z8,1997
w� 'WINIt
This pet tion, if fo d insufficient by the City Clerk, shall be returned
to 1 Z1 Z44 at Numberh/o Street.
I here `indicate my willingness to accept the office of
if duly elected thereto.
(Si ture of Nominee)
3/0/1/9
NOMINATION PETITION
we, the undersigned, registered voters of the City of Fridley,
hereby nominate __ a —lie /it, , whose residence is
for the office of
�, td r��+ i �/�-� e m .�i e Y l�a�✓a� , to be voted for at
the election to be held on the /! zh day of A , 19 9W
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.
NAME STREET AND NUMBER
AN
LI
n-42,1
L,
-.7K 3- '� � Gc
N 0 e�,'0'0', 4-q
/V 1 ver z7,7 fir_
Ori 2u4
being duly sworn, deposes and says, "I
(Name of Circulator)
the circulator of the foregoing petition paper containing signatures,
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 Print)
(Signature of Nominee)
Sub cribed and sworn to before this�day
of 19 -
r i
� t
(Notary ubllc)
y�a.a, mYC=S�Gu''ui�'.�'w` `svei'w�°L4 `'t9vT:S
This petition, if found insufficient by the City Clerk, shall be returned
to la c.K P,"e �n , at Number` ��h�.�o i (�F . Street.
I hereby indicat my willingness to accept the office of axAl
cc if duly elected thereto.
J
(Si Ore of Nominee)
3/0/1/9