Bolkcom, Ann - Ward 3 y NOMINATION PETITION
4
we, the undersigned, registered voters of the City of Fridley,
hereby nominate Jgnrl &Ll Com , whose residence is
for the office of
r ilnc� n saw -- , to be voted for at
41
the election to be held on the l YK day of �4AqA�y , 19
j �-1
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 6?5 STREET AND NUMBER
J f
/4l�
��LIJ
being duly sworn, deposes and says, "I
am the circulator of the foregoing petition paper containing s-i-qnaturEs, --- — ---
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)
(Signature of Nominee)
Subscribed and sworn to before me this day
of , 19
(Notary Public)
This petition, if found insufficient by the City Clerk, shall be returned
to , at Number Street.
I hereby indicate my willingness to accept the office of
if duly elected thereto.
(Signature of Nominee)
3/0/1/9
-, NOMINATION PETITION
o
We, the undersigned, registered voters of the City of Fridley,
hereby nominate , whose residence is
for the office of
to be voted for at
the election to be held on the 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 ARID NUMBER
&��L J�Cnm 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 Print)
ignature of-Nominee)
S cribed and sworn to before m this3 day
� .,� �� tit t,
Smith
res-
L111 � xp�.b�I•o E.4o'Ct
, 7
(Notary rubliCvc�E, a'# � '3SEo
This petition, if found insufficient by the City Clerk, shall be returned
to AV1 II &L-LCtml , at Number (0 9c-�L C ►T-1 Street. n
I hereby indicate my willingness to accept the office of 00-r�Q 3
if duly elected thereto.
A
� C
(Signature Nominee)
3/0/1/9
FORM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
StatQ of Minnesota
sr. No.
County of �Q1�
(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 vf' 1
I reside in the city or township of �'1
My post office address is:
(Zip) �}J` —
(Sign name as wanted on ballot)
Subscribed and sworn to before me this day of 193
(Town), ity) Clerk—Notary Public
SEAL ounty, Minn.
r
Affidavit of Candidate
Filed in the office of the 1
I
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Countyof------------------------------------------
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Minnesota, this-----------------------------day of
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MILLER-DAVIS CO.. MINNEAPOLIS