1997 Public Disclosure Forms Y
CITY OF FRIDLEY
PUBLIC DISCEDSURE STAZEMWT BY MMERS OF ADVISORY BODIES
NAME DATE
ADVISORY OaMMIsS
TO: CITY CLERK
In conformance with Sec. 5.05 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
PARMERSHIP, ETC. ADDRESS INTEREST REST
IUM
(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:
J NON--HOMESTEAD REAL PROPERTY ADDRESS
(Use additional paper if necessary.)
I do swear (or affirm) that this report is a full and tru statement
pursuant to Sec . 5 . 0 5 of the City
(Signature)
Note: This statement must be filed upon appointment or reappointment to an
advisory committee or material changes in financial interest while on
an advisory committee.