Loading...
Hart, David - Ward 1 FORM 11(REVISED 1980)MILLER-DAVIs CO.,MINNEAPOLLf AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING esota State of MTOWN.OR CITY ELECTIONS iO_- ff• No. County of� LT I, Diq-✓to 1.4Iq H7 (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 ofcQ- My post office address is: 7 62 z7✓�-t� ✓1,w� (zip) k` (Sign name as wanted on-ballot) Subscribed andagwo Huta, eZAWY day of 19r SHIRLEY A. HAABAL4 11/ NOTARY PUBLIC- MINNESOTA �`� ANOKA COUNTY r (Town (City) Clerk—lVotary Public SEAL MYCOmmissionExpires May 28,1986 � � !� �� L-- County, Minn. NOMINATION PETItION �- We, the undersigned, electors of the City of Fridley, hereby nominate hUy - f/a R i whose residence is for the office of to be voted for at the election to be held 'on the -6, day of 19�; and we individually certify that we are qualified electors and that we have not signed more nomination petitions of candidates for this office than there are persons to be elected thereto. Name Street and Number ~LV ot D being duly sworn, deposes and says that s/he (Name of Nominee is the circulator of the foregoing petition paper containing signatures, and that - ��ie is gnatures appended thereto were made in his/her presence and are--.-the genuine signatures of the persons whose names they purport to be. 1 I I wish my name to appear on the ballot exactly as follows: IYW IT 7- Please Print) i I i / o ign ure o Nominee Subscr' d and sworn to beforme this day e of 19 Xh� , SHIRLEYSHIREEY A. HAAPAIA <' CL__ NOTARY PUBLIC- MINNESOTA Notary Pu is ANOKA COUNTY My Commission Expires May 28,1986 i II This petition, if found insufficient by the City Cler shall a returned to at Number ,5"a treet. I hereby j dicate my willingness to accept the office of _ if duly elected thereto. gn ure f- ominee) CC1280 • - NOMINATION PETITION ' We, the undersigned, electors of the City of Fridley, hereby nominate &/3/37— whose residence is for the office of to be voted for at the election to be held on the __(; day of and we individually certify that we are qualified electors and that we have not signed more nomination petitions of candidates for this office than there are persons to be elected thereto. Name Street and Number V// ZL AKft 6 D _!�Y� being duly sworn, deposes and says that s/he i' Name of Nominee the circulator of the foregoing petition paper containing signatures, and that the signatures appended thereto were made in his/her presence and are the genuine signatures of the persons whose names they purport to be. I wish my name to appear on the ballot exactly as follows: —DA&Z.b_ 112"lp (Please Print /tSigrfaturt of Nominee Subs be and sworn to before,me this day of 19 • x vw,nnnnnn SHIRLEY A. HAAPALA k07AftY PUBLIC- MINNESOTA ANOKA COUNTY Notary Public) MY Commission ExpiresMsY28,1986 '\A,V This petition, if found insufficient by the City Clerk, shall b returned to I at Number �A - a-CcStreet. I hereby indicate my willingness to accept the office of if duly elected thereto. Sign u of Nominee) CC1280 my or FRIDLEY - • 1111i3L I C M SCLOSURE STATEMENT BY CITY COUNCIL Oil COM-1 11. CANDIDATES NAME DATE TO: CITY CLERK In conror :ince witm Section 30 of the City Cede, I h^rcby make the follov.,ing declaratic►;is regat-0;nq my financial and personal interests: I. Natures of all business corporations, partnerships, other business enterprises, or governmenLal agencies doing business with the City of Fridley or located within the City of Fridley: a. With v;hic.h I have a financial interest. (AS used in Chapter 30, the tenet financial interest shall be deemed to include ownership of more than 10`''• of: The outstanding stock in a ccrporatiun, an interest in a partm-ship, proprietorship, or other business entity, or an interest in real property. Financial ir-tL-rest shall apply to real or per-onal properties ovined by the person rnal;ing the disclosure and by said person's spouse. ) b. With ifiiich I have a personal interest. (As used in Chapter ::0, the term personal interest shall be deemed to app ll., %-.,hey 2-v;r a person regUi red to rake a d i scl os::rc under this Code of ethics shall be associated with a business as an elilpio ee, officer, director, trustee, partner, advisor on consultant. ) tltu•� (.•f G�i,•����.,.,, FINOI�C_IA LII'C�:SOiJ^l_ PARTE:ERSrilfS, ETL. ADDRESS 114TEREST iivTERE ST /tit2i v`• .��i'��-tri ScN /3 (s�o/ ��.�vF,c s <;� l�v� ��.aeF 6v.�S�a�o�.J ur��f-c' H�rei- �y ���,��cy,,�• =>5-y��.- sow. Le•.c�T/t/slei rc� vE<o t/ivo.4it / y 5�. ,✓vim- �-TS-3 (Use additional paper if necessary. ) -- -2- . 2. A list of the non-homestead real property located within the City of Fridley in which I currently have a financial interest: Toll-I,0,.fk TEED REAL PROPERTY ADDRESS (Use additional paper if necessary. ) 0 3. A list of the non-homestead real property locai;ed within the City of Fridley in which I had. a Financial interest within the preceding three years. NUP;-I,G ESTLAD PEAL PROPERTY ADDRESS (Use additional paper if necessary. ) -3- -4- ' • l t 4. A list of the 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 BUSINESC.S ENTERPRISES J I (Use additional paper if necessary . ) I do swear (or affirm) that this report is a full and true statement pursuant to Section 30 of 'the City Code. Signature Note: This statement must be filed annually or when there is a material change in financial interest, or in position held.