Fitzpatrick, Ed - Ward 3 FORM 11(REVISED 1980)MILLER-DAVIS CO.,MINNEAPOLIS
AFFIDAVIT OF CANDODATE & RECEIPT FOR FILING
TOIfWN OR ZITY ELECTIONS
State of Minnesota ff No.
County of (�Z O✓
(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 of
My post office address is:
(S' name as wanted on ballot)
Subscribed and sworn to before me this C49 day of 19 v
(T w Cit Cf — otary Public
SEAL T��_�.' - ^ounty, Minn.
r a
• NOlMINATION PETITION,
We, the undersigned�7glstelred vote of the City f Fridley,
hereby to , whose residence is
for the office of
61.1 , to be voted for at
the election to I held on the 3 day of , 19 ;
and we individually certify that we are registered v ers and that we
have not signed more nomination petitions of candidates for this office
than there are persons to be elected thereto.
MNE STREET AND NUMBM1 49—
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z_ ! � . 834/'�ute►r�wa4� . !�e� i(/.�-,�,
AV
41
A&tAL W",Lw avz-" 45� GI
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u1(-R r) ;:3, r 7Z PR 721 Cl<r being duly sworn, deposes and says, "I
(Name 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."
I wish my name to appear on the ballot exactly as follows:
.�
=d zri _c
(Please Pr'
a(Sre o(Rominee)
Subs ribed and sworn to before me this day „
WALTER J. MULCAHY
NOTARY PUBLIC- LUCIAESOTA
RAMSEY COUNTY
-(Notary lic) "my Commission Expires Oct.07,1988
• " i
This it' if four insufficient by the City Clerk, shall be re ned
t , at Number 2
I byis my willingness to accept the office
if duly elected thereto.
( gna re Nominee)
3/0/1/9
NOMINATION PETITIOAI
We, the undersigns istered voters of the;:zzse
eley;
hereby nomina a residence is
for the office of
to be voted for at
the election to be held on the day of , 19
and we individually certify that we are register 3voters and that we
have not signed more nomination petitions of candidates for this office
than there are persons to be elected thereto.
STREET AND NUMBER
c4d ST 4-�
04
PZ -t
-460 ToPPy. J," AYE,
0,
—70 S` :
J'
E10to X9-0,O -Tr/ j 2 F 4 7 2t e-k- , being duly sworn, deposes and says, "I
(Name 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."
I wish my name to appear on the ballot exactly as follows:
(P ease Prin
(S.
Ahature o )
Subscri d and sworn to before me thisZday
of , 19�. x
■
WALTER J. MULCAHY
NOTARY PUBLIC-MI INESOTA
(Nodhxy RAMSEY COUNTY
11C) My Commission Expires Oct.07,IN&
x
This t' ion if found i ufficient bythe Cit Cl k, shall be re rnep
to , at Number
hereby indica a willinpw- e-to accept the office addo
if�Dly elected thereto.
i
( gna iuregTf Nominee)
3/0/1/9
CITY OF F ,MLEY
PUBLIC DISCLOSURE STATEMENT BY CITY COUNCIL ORIDATESS
NAME // Z. J. ✓I t DATE 8
17
rf A 7�' /�
TO: 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 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 PERSCNAL
PARnI RSHIP, ETC. ADDRESS INTEREST INTEREST
(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:
NON-HOMESTEAD REAL PROPERTY ADDRESS
(Use additional paper if necessary.)
r � 1•
1
3. A list of the norr-hcmestead real property located within the City of
Fridley in which I had a financial interest within the preceding three
(3) years:
NON-HOMESTEAD REAL PROPERTY ADDRESS
(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.)
NATURE OF BUSINESS - OF ALL ODRPORATIONS
NAMES PARTNERSHIPS, OR OTHER BUSINESS EVIERPRISES
(Use additional paper if necessary.)
I do swear (or affirm) that this report is a full d rue statement
pursuant to Sec. 5. 04 of the Cit
%). Q.
/ " (Signat
Note: This statement must be filed annually or when there is a material
change in financial interest or in position held.