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Barnette, Robert - Council at Large FORM(REVISED 1980)MILLER-DAVIS CO.,ST.PAUL,MN AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING TOWN OR CITY ELECTIONS State of Minnesota No. ss. County of 0 k6u )7 (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 &LIn I reside in the City or Township of �✓ d My post offi�.�ress is A ) /(/ - ^ �`� C z (Zip) SKOGEN (Sign name as wanted on ballot) F�— '[FRA A NNESOTXSub s� J120MMM day of ct O 19��� oExP`res.} T n), (Ci )Clerk—Notary Public SEAL' – -�''' v County,Minn. W City of Fridley Nomination Petition FR[D&f We,the undersigned,registered voters of the City of Fridley,hereby nominate C 6 ,°T C11 f pr✓�:. C (. &:rj` ,-%C. ,ti whose residence is ar`I f,. tC� t_.K' /^ '�-� �"� ,for the office of !} rp a �'�.c ,to be voted for at the election to be held on the day of 2004; 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 Address _ s 7:,i/". ua� i 4 �u re f) 1'arusyh �� ✓ . IC rtSf- &A01 7-11- 0 being duty 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 exactlyas follows: x3©6 R547e (Please Print Name) // This petition, if found insufficient by the City Clerk, shall be returned to 2L9 J6 _2 r at Fridley, Minnesota. I hereby indicate my willingness to accept the office of (Pt- if duly elected thereto. (� (Signature of Nominee) Subscribed and sworn to before me this qday of - eki 2004. PF'a"— (NotaryPublic) °"F DEBRA A.SKOGEN NOTARY PUBLIC-MINNESOTA MY COMMI5SI01", c?;P!7ES JAN.31,2005 W riCity of Fridley Nomination Petition CIiYOF FRIDLEY We,the undersigned,registered voters of the City of Fridley, hereby nominate 0016 gam^) COUNcIL,M whose residence is Sy I R 1 CE CRt--E"K- BLVD ,for the office of A-7- L-prPL&C ,to be voted for at the election to be held on the day of , 2004; 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. i7 1 Date: Printed Name and Signature Address /3/ 6 A Nn cv 4 y (�— cl yA/cy//ate c e / S o f_� -b4 6575` MoNRoe Sr F . fa;d/!j MN 7--1:1 -0 e �E 13,# 'VF �-,a,OF 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 toa pear on the ballotexactly as follows: (Please Print Name) This petition, if found insufficient by the City Clerk, shall be returned to at Cj I Kz,�v Lx,.,c� 61ucl 'Fridley, Minnesota. I hereby indicate my willingness to accept the office of Curti n j,4, if duly elected thereto. '' (Signature of Nominee) Subscribed andsw to efore me this l�day of i , 2004. it (Notaryublic) ;. DEBRA A-SKOGEN NOTARY PUBLIC-MINNESOTA MY COMMISSION EXPIRES JAN.31,2005 City of Fridley Public Disclosure Statement By City Council Members or City Council Candidates Name: ,80,5 13A/Z!►/4:-:_�%C Date Position Title: GmyN G/c.m E�/�t72 F9-7 ,4,q2G E 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 Financial Interest Personal Interest Partnership,Etc. dV OA!E (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 Iy pA/C (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 NoN E (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 of Business—of All Corporations, Names Partnerships, or Other Business Enterprises NvNE (Use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Secti 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. City Y of Fridley Public Disclosure Statement By City Counci Members or City Council Candidates Name: Date Q Position Title: In conformance with Section 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 Financial Interest Personal Interest Partnership, Etc. Wp i 7S Rv4t,w Ad (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 //L' .21 /i- A v-� (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 of Business—of All Corporations, Names Partnerships, or Other 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. (Si ature) Note: This statement must be filed annually or when there is a material change in financial interest or in position held. City of Fridley Nomination Petition FRIDOLEY We,the undersigned,registered voters of the City of Fridley,hereby nominate whose residence is �`��� ' (� �;��' �'�— , for the office of i1':� ,to be voted for at the election to be held on the I" day of M, }.� , , 2004; 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 Address gpe Ei-e-�CreeAL MVIV, eLA CO fgIAO Awe,z"" S\-f ve r L-*1&r 7 2,�' I/j/04- /p� y .._� � 2C-0 L.l A) , 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: (Please Print Na e) / This petition, if found insufficient by the City Clerk, shall be returned to SGa j 1 L IV) at �k Fridley, Minnesota. I hereby indicate my willingne s to accept the office ofAI,'G;Q if duly elected thereto. (Si ature f Norn ee) Su ribed a d sworn to be e m this/iday of G , 2004. ta� RUTH MARCELLE EVERETTE NOTARY PUBL"INKSOTA (Notary Public) MY COMMISSION EXPIRES JANUARY 31,2005 FOFCity of Fridley Nomination Petition FRIDU Y We,the undersigned,registered voters of the City of Fridley, hereby nominate S"77zwV whose residence is V0- 6 l 1W A 1`( ,for the office of ! d/I ,t be voted for at the election to be held on the P"'day of 416) N —, 2004; 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 Address - - Rachel au hz h am 1421 North Nnube Pd , Pr I'd AA Wl� A( - 13 -4 �,i n 4- Owh !_/ J tom► ? �J,�� � �►� I�/�ll �� ��1 4 , /v k A Z9 �- �3 od .e Eacice Qn c98oT.ny) he f,, j LA A Irt LS EP 7/51V RIUL—RwEW TIERQ 1P46YMA,. Jac Ll N , being duly sworn, deposes and says, "I am the circulator of the foregoing Ss V32 petition paper cont ining 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: se,d;T )-ti/,jd (Please Print me) This petition, if found insufficient by the City Clerk, shall be returned to at Fridley, Minnesota. I hereby indicate my willingness to accept the office of IZ'AVgyf-__ if duly elected thereto. ,&& (SignaAe o Nomin ) u ribed and swornto bef e me is dday of ,2004. tN'dtary Public) At / RUTHMARCEUEEVERETIE �J NOTARY PUBLIC-4 N NIMA MY COMMISSION EXPIRES ,JANUARY 31,2005