Bolkcom, Ann - Ward 3 SRM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
State of Minnesota
/ JJ No.—�—
County of— k-c.-
(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 Wct r' 861f,E2 Lj �4nj j0d '
I reside in the city or township of '-�-
My post office address is:
}
(Zip)
Aj
(Sign name as wanted on ballot)
Subscribed and sworn to before me this day of , 1
Mary MargareD
(To ),(C y Clerk—Notary Public
NOTARY PUBLIC-M
SEAL ANOKA COUCounty,Minn.
Ory Comm.Exp.Jul
NOMINATION PETITION
We, the undersigned registered voters of the City of Fridley,
hea.rby nominate , whose residence is
! for the office of
to be voted for at
the election to be on the day of Adtfid,�A, 19qv;
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.
/ DATE NAME STREET AND ADDRESS
IS -
y0 S� to �.� �a ti E• 'Z-'""'
Z447 Y_ 11_0�14WAZ F40
VW
Dill
-
being duly sworn, deposes and says, "I am
(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. n
I wish my name to appear on the' ballot exactly as follows:
(Please Print)
^w^ a�
® , Mary Margaret Smith �,�
¢ ,��3ly PUBLIC-MINNESOTA
(Signature of Nominee)
A ANOKA COUNTY
My Comm.Exp.July 28;1997 �
SIIbScr e me this/,-/ day
of .. , .,19�.
(
Otary6ADub11
This petition, if found insufficient by the City Clerk, shall be returned
to /�joStreet.at Number l
I h by indicate my willingness to accept the office of :i
( ' f )IV if duly elected thereto.
( gnature of Nominee)
6/94