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Barnette, Bob - Council at Large .y� o,�r.uox el,� Flling# ' wP. Office of the Minnesota nn - H?_ Cash/Check# W, Secretary of State Amount '��'1S58x Affidavit of Candidacy All information on this form is available to the public.Information provided will appear on the Secretary of State's website at www.sos.state.mn.us. Note:If filing for partisan office and not a major party candidate,you must file both an affidavit of candidacy and a nominating petition:"Candidates for any partisan office who do not seek the nomination of a major political party shall be nominated by nominating petition as provided in sections 20413.07 and 20413.08,and. . .shall file an affidavit of candidacy as provided in section 204B.06."(Minn. Stat.section 20413.03). Please pr.,inntt ort e. Name(as it will appear on the ballot): / 4pp,,/ �0#12�G lJ C Office Sought: CO UNC-/L-m A-N A`7- 1-41266-7 o g istrict#: For Partisan Office Provide Political Party or Principle: For Judicial Office Provide Name of Incumbent: Legal Residence Address Street Address: .5-41/ R 1 C�EE� �4 V D City: Fla 117 L.-1 State: M Al Zip: 35 32 Campaign Contact Information (� Street Address: LA I City: t C� �" State:Mt*J Zip: ��S �3 2- Website: Email: Phone Number: ( For all offices,I swear(or affirm)that this is my true name or the name by which I am generally known in the community. If filing for a state or local office,I also swear(or affirm)that: • I am eligible to vote in Minnesota; • I have not filed for the same or any other office at the upcoming primary or general election; • I am,or will be on assuming office,21 years of age or more; • I will have maintained residence in this district for at least 30 days before the general election;and • If a major political party candidate,I either participated in the party's most recent precinct caucuses or intend to vote for a majority of that party's candidates at the next general election. If filing for one of the following offices,I also swear(or affirm)that I meet the requirements listed below: • United States Senator-I will be an inhabitant of this state when elected and I will be at least 30 years old and a citizen of the United States for not less than nine years on the next January 3rd,or if filled at special election,within 21 days after the election. • United States Representative-I will be an inhabitant of this state when elected and I will be at least 25 years old and a citizen of the United States for not less than seven years on the next January 3rd,or if filled at special election,within 21 days after the election. • Governor or Lieutenant Governor-I will be at least 25 years old on the first Monday of the next January and a resident of Minnesota for not less than one year on election day.I am filing jointly with • Supreme Court Justice,Court of Appeals Judge,District Court Judge,or County Attorney-I am learned in the law and licensed to practice law in Minnesota.My Minnesota attorney license number is and a copy my license is attached. • State Senator or State Representative-I will be a resident of Minnesota not less than one year and of this district for six months on the day of the general or special election. • County Sheriff-I am a licensed peace officer in Minnesota.My Board of Peace Officer Standards and Training license number is and a copy of my license is attached. • School Board Member-I have not been convicted of an offense for which registration is required under Minnesota Statutes,section 243.166. Count MunicipA School District,or Special District Office-I meet any other qualifications for that office prescribed by law. �-- Subscribed and sworn before me this an id to Signature day of /-�1��v1� I -.)L y0 Date CYNTHIA J.RUSCHY Notdy public or other officer empowered to rr�NOWY stamp) take and certify acknowledgments. SohoRew.s-ox white copy—Filing Officer yellow copy—CFPD Board goldenrod copy—Candidate pink copy—Public Information -� ► v AMC RD City of Fridley Nomination Petition FR[D r We,the undersigned,registered voters of the City of Fridley,hereby nominated whose residence is iJ yl /�l C6 C'/27G/��VO , for the office of��✓Gy►'// earto be voted for at the election to be held on the day of 20_; 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. Date: Printed Name and Signature Address a R �I-cep d 7- t • jog �b w1 �• elum a + 6575 1'f'Io ja E Sr NE IN _ _p5 101 c )50t6 o8f)21V�")9-E , being duly sworn, deposes and says, "I 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 by name to appear on the ballot exactly as follows: 1-;50/3 A3A1LVz57J`b: (Please Print Name) This petition, if found insufficient by the City Clerk, shall be returned CA at 1 Z� t 4. Cies l` ,Fridley,Minnesota. I here y indica ingness to accept the office of chyc-ic m /,I-r4 "E if duly elected thereto. (Signature of Nominee) Subscribed and sworn to before me this 3 day of�w�_,2006 � if*CYNTHIA=NAJ.RUSCHY (Notary Public) Mft c- ,S z z e .� Z. t City of Fridley Nomination Petition FR�tDL�EFY We,the undersigned,registered voters of the City of Fridley,hereby nominate 13©6 )51+"e-- 7TE whose residence is 5;'l/ I C-6: Al—VD, for the office o6VWC/cM01V 13-r1AWfE, to be voted for at the election to be held on the day of , 20_; 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. Date: Printed Name and Signature Address y \��Y ' �f•- o �; T 5te< I (�P6- sL >, 2O�b � ��cc A- lie rr�r� � r &,0 8 2N'6772E , being duly sworn, deposes and says, "I 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 by name to appear on the ballot exactly as follows: 1366 819.P- /65-777E (Please Print Name) This petition, if found insufficient by the City Clerk, shall be returned to at S-`-� I ,Fridley,Minnesota. I here indica n lingness to accept the office &E if duly elected thereto. (Signature of Nominee) Subscribed and sworn to before me this 3 day of�k_�,200 071� k� 3 (Notary Public) CYNTHIA J.RUSCHY Notary Pubito.M1{nnes0ta Mb n INO"Jen 91.2012 City of Fridley Public Disclosure Statement By City Council Members or City Council Candidates Name: 6e)f3 84-12,Ve577- Date -7 - 3 - F OOV Position Title: w UA1c_j cmc/ 14-T L-X3-210 In conformance with Section 5.04 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 Chaptez 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 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.) Name of Business, Address Financial Personal Interest Partnership, Etc. 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) City of Fridley Public Disclosure Form Page 2 3. A list of the non-homestead real property located within the City of Fridley in which I have had a financial interest within the proceeding three years. Non-Homestead Real Property Address (use additional paper if necessary) 4. A list of 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 Business Enterprises (Use additional paper if necessary) I do swear(or affirm)that this report is a full and true statement pursuant to Section 5.04 of the Fridley City Code. Go� (Signature) Note: This statement must be filed annually or when there is a material change in financial interest or in position held. i MINNESOTA SECRETARY OF STATE ELECTION CANDIDATE INFORMATION FORM (VOLUNTARY DISCLOSURE) Please type or print clearly You are invited to complete this form and leave it with the filing office for public information. The Secretary of State does not edit the information submitted. Information submitted by state and federal candidates will be scanned and placed on the Secretary of State's web site:www.sos.state.mn.us. If you are filing for state or federal office at a county,please FAX a copy of this complete form to us at 651-296-9073 if you wish this information to be published on the web. Your Name: B06 Age: Your address: C42 �K P3 4-VD Telephone Number: '76 3- 5-7 y` 96-9 57 E-Mail: ,P5LN 7�c�2 °�' CZ r4/06&y'A4A,'Web site: Gt S Occupation and employer: tq&7-1 k2 ED Office Sought: GO Ui1lG1 L-M 4-l) Political party or principle: Current office held:LoelA c4 c-M&,y A-i" First year elected or appointed: /q74 Previous elected or appointed public offices: Endorsements: Comments or filing statement(use this space only): rci Ithat %' mation provided on this form is true. -7-3-ok adate Signature Date If you have any questions,please contact the Elections Division at 651-215-1440. Please submit this information: Fax: 651-296-9073 Mail: 180 State Office Building, 100 Rev Dr Martin Luther King Jr.Blvd,St.Paul,MN 55155