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Lewis, Richard - Mayor FORM 11(REVISED 1950)MILLER-DAVIS CO..MINNEAPOLIS a AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING TOWN OR CITY ELECTIONS State of Minnesota No. JJ. County of— (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/filled for any other office at this election. I am seeking election to the office of < ' /A b/2, I reside in the city or township of �� V My post office address is: / (Zip) ,6 3d 3a ign name as wanted on ballot)C�/ da f P19 Subscribed and y or 1 JOAN M.BUDNICK NOTARY FURC"MIIXINIM (To n) ) Clerk—Notary Public yiponr�6wsia11.11N SEAL County,Minn. NOMINATION PETITION We, the undersi registered voters of the City of Fridley, Z hearby nominate E�_F w2 S�j p_. , whose residence is N.E . FAZzo,-CY 1`�°k� .S5V3� for the office of f,VC) to be voted for at the election to be held on the y day of4yeroj?Lq 19It( f 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 74 1 OK 71 AxE t � C-"-hjLO "J.-I-C. 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. " I wish my n to appear on the ballot exactly ollows• A .Lxz (Pleas rint) nature of Nominee) Subscrbe and sworn to beforee this t day R. PM- of , 19 . JOAN M.BUDNiCK 1)'L/- 0 WTMV F=-ABTA y C� WCONAM06OUJALAM 7tion, tary Public) This et if found insufficient by the City Clerk, shall be returned x,21 z at Number � ( Tai} Street. I h arb Ln icat�my willingness to accept the office of if duly elected thereto. ignatu f nee) 6/94 CITY OF FPJ= C DISCLOSURE STATEMENT BY CITY COUNCIL OR COUNCIL CANDIDATES NAME T NA6ZQ L w DATE -7 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. Names- 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, EIC. ADDRESS INTEREST INTEREST (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: NOIR-HOMESTEAD REAL PROPERTY ADDRESS NO IV JI (Use additional paper if necessary.) _ l 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: NW-HOMESTEAD REAL PROPEFCY AWRESS _ —WO�N (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 list shall indicate the name or names of such persons or persons having such interest in said enterprise.) NA7.M OF BUSINESS - OF ALL ODRPORATIONS NAMES PA M ERSHIPS, OR UMER BUSINESS ELlMd RISES (Use additional paper if necessary.) I do swear (or affirm) that th' eport is a full rue st ment pursuant to Sec-. 5.04 of the Code. Note: This statcnent must be filed annually or when there is a material change in financial interest or in position held.