2001 Public Disclosure Forms City of Fridley
Public Disclosure Statement
By Members of Advisory Bodies
-, c Dat Name: vD(�
Position Title: ;t:- c— r
In conformance with Section 5.05 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. /V AIQ--.
(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
N 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. A10 IV-e--
(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.)
Dame of Buscot ramal ink '
Partnership,Etc �Y � � '�
(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:
i 1 31 3'L
RN?
(use additional paper if necessary)
I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the
Fridley City Code.
(S' tune)
Note: This statement must be filed upon appointment or reappointment to an advisory comimttee or material changes
in financial interest while on an advisory committee.
City of Fridley
Public Disclosure Statement
By Members of Advisory Bodies
Name: `
Position Title: t Date
A
In conformance with Section 5.05 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•/o 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.) _
Name4fless' �gd�
PPS Etc.
(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:
Em
MY[' ��'
(use additional paper if necessary)
I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.05 of the
Fridley City Code.
(Si e
Note: This staterimt must be filed upon appom mart or reappointment to an advisory committee or material changes
in financial interest while on an advisory committee.