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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.