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Barnette, Bob - Council at Large FORM 11(REVVED 1980)MILLER-DAVIS CO.,MINNEAPOLIS AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING State of Minnesota TOWN OR CITY ELECTIONS � County of_ fs No. (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 CD VNG 1(. I reside in the city or township of_ F2 In (-Ey My post office address is:_ .54// R/CE CR&9,e_ 62-VO /ilb L&ry (Sign name as wanted on ballot)( Subscribed and sworn to before me this � � day of 1 �.�.��. MARY MARGARET SMD ` NOTARY PUBLIC-MINNESOwn), it l ary Public SEAL • - ANOKA COUNTY County,Minn. .•�• My Commission Expires Jan.31 a CITY OF FRIDLEY PUBLIC DISCLOSURESTATEMENTBY CITY COUNCIL OR COUNCIL CANDIDATES NAME Q,�j�'�T .0, i i2Jl�' E DATE "I Ce - 176 TO: CITY CLERK In conformance with Sec. 5.04 of the City Code, I hereby make the, following declarations regarding my financial and personal interests: 1. Name 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 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 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 FINANCIAL PERSONAL PARTNERSHIP, ETC. ADDRESS INTEREST INTEREST ego NE (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 N'fi N'j5_ (Use additional paper if necessary. ) 3 . A list of the non-homestead real property located within the City of Fridley in which I had a financial interest within the preceding three (3) years: NON-HOMESTEAD REAL PROPERTY ADDRESS WOM5 (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 I know one or more other persons covered by this code of ethics also having a financial interest in said enterprise. (This lisp shall indicate the name or names of such person or persons having such interest in said enterprise. ) NATURE OF BUSINESS - OF ALL CORPORATIONS, NAMES PARTNERSHIPS OR OTHER BUSINESS ENTERPRISES A10 016 (Use additional paper if necessary. ) I do swear (or affirm) that this report is a full and true statement pursuant to Sec. 5. 04 of the City Code. ,via -� � (Signature) Note: This statement must be filed annually or when there is a material change in financial interest or in position held. NOMINATION PETITION We, the undersigned, registered voters of the City of Fridley, hearby nominate �f 1���/2T 81WA1=177"—E , whose residence is 6y/ j'lc CkeeEE &L VP , for the office of C©oOI 61 e- -�?- L�}F'-lam , to be voted for at the election to be held on the S-`T+f day of A/0 L 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. DATE NAME STREET AND ADDRESS ., 1 �`�_� �O►-IAt�� �. �� urn-. // mCr.�RC�. �i. �.�.` 7f 7 9 GaG .r �s` 7V , Rod (-8 Lq(o 4�/' 7 /0 9 9� Ale ex .cJZ � 1'0-4- 7i h'm3e)2;r 8fI-1W&-77-,5 , 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. '1 I wish my name to appear on the ballot exactly as follows: BOB BfV—A/F7-1-6 (Please Pri (Sig ature of Nominee) subscribe ------- of , 19 NANCY K.MONTGOMERY NOTARY PUBLIC-MINNESOTA JVD MrQMMWWo LVftJW31.2= Notary Public) This petition, if found insufficient by the City Clerk, shall be returned to 1301at Number SZi`1 �Q10Enp-&-Et '54 t':0 Street. I hearby indicate my willingness to accept the office of C:i, (VAIc1c- -4-1 - 4A266�- if duly elected thereto. (S gnatu a of Nominee) 6/94