Jorgenson, Nancy J - Council at Large FORM 11(REVISED--qSO)MILDA-DAVIS CO.,MINNEAPOLIS I:
AFFIDAVIT OF CANDIDATE & RECEIPT FOR FILING
TOWN OR CITY ELECTIONS
State of M'nnesota ff No. Z3
County of
I, Net A)t y �, Fie'/d 5 o Its
(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. y�
I am seeking election to the office of
I reside in the city or township of . -
My post office address is: 7 3 d YO-44
X46�
ig a as wanted on ballot)
Subscribed and sworn to before me this day of , 19
( own),(City) Merk—Notary Public
SEAL County, Minn.
NOMINATION PETITION
We, the undersigned, registered voters of the City of Fridley,
J.
hereby nominate e n So YI whose residence is
573 a o S/ i d S , for the office of
eu.1 C to be voted for at
the election to be held on the ` _day of �, 19
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.
NAM STREET ArD
r
AIL
Q J�
y .
'23VI �1�4
1
.J, being duly sworn, deposes and says, "I
Made of Circulator)
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."
wish my name to appear on theballotexactly as follows:
h L .J. �J 01)
(Plea Print)
($i ur of )
Subscrihoi d orn to beforeis day '
of , 19M
(Notary Public) ,X/"Z
This petition, if found insufficient by the City Clerk, shall be returned
to g,gPzjSaA, at Number 0 P61 b< .!a. A) E. Street.
I hereby indicate my willingness to accept the office of QO%Lnt. l
A -QMt- if duly elected thereto.
( ure e)
3/0/1/9
i
NOMINATION PETITION
We, the undersigned, registered voters of the City of Fridley,
hereby rwminate ` c '*�%G n whose residence is
5 S f. 4 100- S593 , for the office of
to be voted for at
the election to be held on the day of ZLQO-thu, 19 St •
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.
NAME STREET AND ICER
'7558 ` ±4— S-i3. E�.
/ter P
_ /�
,p (e
a ' �' `
JU
5-7.3
being duly sworn, deposes and says, "I
( of Circ ator)
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 my name to appear on the ballot exactly as follows:
*42/7c- J
(Please Print)
(S' t e of )
Subscr' d c7 sworn to before me Ois day
of I A
(Notary Public) >, 6 - .-
This
;This petition, if found insufficient by the City Clerk, shall be returned
to f. 194enspn , at Number 5.7 3 n Pe R 33- M•C Street.
I hereby indicate my willingness to accept the office of 0,0LILAc •
CL+ LQif duly elected thereto.
, 3-
( ur of )
3/0/1/9
I . �
CITY OF FRIDLEY
PUBLIC DISCLOSURE STATEMENT BY CITY OOUNCIL OR COUNCIL CANDIDATES
NAME n J DATE �� "� o
T0: CITY CLERK
In conformance with Sec. 5 . 04 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 51 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 PERSQNAL
PARTNERSHIP, EIC. ADDRESS INTEREST IN-VEREST
'��'��`0?0 /`eMn:C l a JC dn, �c `n., �/ /'8%� If llJ.h .C,' � (��D .���{)
lodZ _ZC�0'>
(Use additional paper if necessary.)
2. A list of the non-homestead real px-operty located within the City of
Fridley in which I currently have a financial interest:
NW-HOMESTEAD REAL PROPERTY ADDS
(Use additional paper if necessary.)
t
3. A list of the non-homestead real property located within the City of
Fridley in which I had a financial interest within the preceding three
(3) years:
NOWHOMESTF.AD REAL PROPERTY ADMWS
(Use additional paper if necessary.)
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.)
Nk= OF BUSINESS - OF ALL ODRPORATIONS
NAMES PAMMMSHIPS, OR OMER BUSINESS WMPRISES
✓h r
JZ C/i 3 >
7
(Use additional paper if necessary.)
I do swear (or affirm) that this report is a full and true statement
pursuant to See. 5. 04 of the City Code.
(S' q e)
Note: This statement must be filed annually or when there is a material
change in financial interest or in position held. _ -