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Werner, Tim - Mayor C�G3�5��-4033 FORM(REVISED 1980)MILLER-DAVIS CO.,ST.PAUL,MN 41 "k AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING TOWN OR CITY ELECTIONS State of Minnesota No. SS. County of A%-, . t r We r (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 I reside in the City or Township of Ftp, My post office address is 64 J-L1 ACS L j 5 T, A)E FR tbLq. Yx /ba (Zip) S5"Y3z (Sign name as wanted on ballot) a U Subscribed and sworn to before me this t!L'` day of , own), City)C erk Notary Public SEAL d County,Minn. AM LrCity of Fridley Nomination Petition FRIDL�EFY We,the undersigned,registered voters of the City of Fridley,hereby nominate -1,/f-h a T/j y (i C e,JEe / �. , office of ,to be whose residence is �� z-`{ � -� for the o voted for at the election to be held on the "? '�T– day of 2000; 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: Printed Name and Signature Addresrsr' n LLI dLaLi 2Lo—a --r—o,o1q y wc v��c LA -6Bil L 1 �'i'� �r/ �e- 6 &6 & l �� lv � © � ( �-�e.��� 1, Zlr-ta Z,44� 44 1 k o j t C<�c `e �t 18 ' av44 A14, �i✓�0" ,being duly sworn,d poses and says,"I 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 by name to appear on the ballot exactly as follows: Ti m W e r,✓e e- (Please Print Name) This petition,if found insufficient by the City Clerk,shall be returned to yyi (,( C k/tR , at LION`7 ,Fridley,Minnesota. I hereby indicate my willingness to accept the office of MQ U n if duly elected thereto. .00 �— (Signature of Nominee) Subsc and sworn b e me this eday of 2000. A.SKOGEN (Not Public) 0 "''�w� ��auc-u+Ara OTA MY COMMISSION EXPIRES JANUARY 31,M LrCity of Fridley Nomination Petition CIiYOF FR[D W We,the undersigned,registered voters of the City of Fridley,hereby nominate lt+o7�f/ U �^��✓ whose residence is U x"I /ably ST ,for the office of I' tl�n ,to be voted for at the election to be held on the "7 ti- day of 2000; 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: ,� / Printed Name and.Signature /Apddpress�y/ /O 0 D'�"' 1 Ida r qac et e h rl d b O O� /97Oxiae-.G�/ /!• G, r Be ��M We b S,2 S 114 avc. N, 0-1 _d� 17 /�/SQ71�f'7rJ eY � n�li�LSL y- 2�y� /`e'/ ``. -F/rh I,J e��✓e� ,being duly sworn,deposes and says, "I 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 by name to appear on the ballot exactly as follows: 'riM Wcr.JCr (Please Print Name) This petition, 'f found insufficient by the City Clerk, shall be returned to t jf� ,Fridley,Minnesota. I hereby indicate my willingness to accept the office of if duly elected thereto. (Signature of Nominee) Subs ed and swo t e ore me this day of 2000. .�••••� D SyOGEN (Notary Public) WT^W PU SIRES MY COMMISSION jANUARY n City of Fridley Public Disclosure Statement By City Council Members or City Council Candidates Name: T,^ U e i'a e-r Date Position Title: o,_at,�, In conformance with Section 5.04 of the Fridley 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 one 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, Address F nanciat interest Personal Interest Partnership,Etc. (�S4 fR— a�W�s C�klf co,. s k i (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 (use additional paper if necessary) 3. A list of the non-homestead real property located within the City of Fridley in which I have had a financial interest within the proceeding three years. Non-Homestead Real Property Address. (use additional paper if necessary) 4. A list of 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.) Nature ofBusiness—of All Carpo ions, Names PartneYshhps,or C?ther"Business enterprises (Use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.04 of the Fridley City Code. (Signature) Note: This statement must be filed annually or when there is a material change in financial interest or in position held.