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Tillberry, Tom - Ward 1 office of the Minnesota Secretary of State Filing# AFFIDAVIT OF CANDIDACY Cash/Check#'"Clov Instructions Amount$ All information on this form is available to the public.Information provided will be published on the Secretary cif—States went .If filing for Partisan office and not a major party candidate,you must file both an affidavit of candidacy and a nominating petition.(Minn.Stat.2048.03) Candidate Information Name and Office Candidate Name(as it will appear on the ballot) 7-o^I ��/bp+'r / /s ` C.�vrvc l t_ M�r18�2 W AkO District# Office Sought i-h,dots/ Ci �-y For Partisan Office,Provide Political Party or Principle For Judicial Office,Provide Name of Incumbent Residence Address Do not complete if residence address is to be private and checkbox below is marked.All address and contact information is optional for federal, judicial,county attorney,and county sheriff office candidates. Street Address 7 oo WE City Pir-i elff y State Nl A1 Zip Code My residence ad/dress is to be classified as private data.I certify a police report has been submitted or I have an order for protection for my (or my family's)safety,or my address is otherwise private by Minnesota law.I have attached a separate form listing my residence address. Campaign Address and Contact Candidate Phone Number(Required) ( 1 2.- 7 " T-g 77 Campaign Contact Address(Required for those who have checked the box above): Street Address 7�® col !S S%SS r PP t J r�c 7 IV.4 City Fy-t cl k y State tir Zip Code .�1t/37— Website Email Te- Fi/fble y /'✓ S'm - Co'''''t Affirmation J 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(except as provided in M.S.2048.06,subd.1(2)); • 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-1 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 of 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-1 have not been convicted of an offense for which registration is required under Minn.Stat.243.166. • County,Municipal,School Di or Speci o ce-I meet any other qualifications for that office prescribed bylaw. Candidate Signature Date 5—oR-/,r Subscribed and swa to ef01 6*AAA& ore e is �� day of 20 DEBRA A.SKOGEN Notary public or other officer a powered to take and certify acknowledgement NotaryWeM**fflhS0ta White Copy-filing Officer Yellow Copy-CFPD Board Pink Copy-Public Information Goide _41,2020 UOUNTY OF ANOKA Ak OFFICE OF ELECTIONS & VOTER REGISTRATION WN , COUNTYPHONE: ( 2018 AutoMARK Pronunciation Form In 2006,a second voting system was adopted which is specifically designed to assist voters with physical disabilities—the AutoMARK. The AutoMARK is a ballot marking device that individuals with physical disabilities may use to vote privately and independently. One of the unique characteristics of the AutoMARK is that it is programmed to speak each candidate's name. As a result, we are asking candidates to provide a phonetic spelling to ensure that the AutoMARK pronounces each candidate's name correctly. Name of , Candidate: 7-o m T 1 f b=e rr V Phonetic Spelling: / y Office sought: Fr; d/, i Office of the Minnesota Secretary of State ELECTION CANDIDATE INFORMATION FORM (VOLUNTARY DISCLOSURE) Instructions Federal and State candidates are invited to complete this form in whole or in part.Submit it through the filing officer or by sending it to the Secretary of State via email elections.de ta)state.mmgs)or mail; 180 State Office Building, 100 Rev. Dr. Martin Luther King,Jr. Blvd.,St. Paul,MN 55155-1299 Information submitted on this form will be published on the Secretary of State's web site.The Office of the Secretary of State does not edit the information submitted.Additional sheets will not be published. Candidate Information Candidate Name —/ 0 T//6 crr Office Sought Fr; /e� Cl ,-kL`j Political Party or Principle Address 7 00 M i ssi SS:pp, �: NF Fr-,`t//�r MIAJ '5_:TV32 Preferred mailing address(if different) Telephone /Z _ 7/6 -®S871 Fax E-Mail z_'C,-r7 (0015n,C_001 Web site Occupation and Employer rLc�o l .�Hst/v,�� /�oSP✓� /� 4-r,. 14a-'Age 5-4/ Current Office Held First Year Elected or Appointed Previous Elected or Appointed Public Offices Fric/ki Scge ARO r .2©-5- A.,A, NIN N� sc a Rep�cs�«f���yes — .200 20/2 Endorsements Comments or Filing Statement(use this space only) I certify that the information provided on this form is true. Candidate Signature Date Revised 312014 1 i City of Fridley Fddlty Public Disclosure Statement By City Council Members or City Council Candidates Name: r _ Date 5--62 S-- Position —Position Title: Cc AY'cc%- Sit,e ct /s 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 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 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 einployee, officer, director, trustee,partner, advisor or consultant.) Name of Business, Address Financial Personal Interest Partnersl' , Etc. Interest (use additional paper if necessary) 2. A list of the non-homestead real property located within the City of Fridley in which 1 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 1 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 l 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. ('Phis 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. —.--- (S��) Note: This statement must be filed annually or when there is a material change in financial interest or in position held. 7 t City of Fridley Nomination Petition We,the undersigned, registered voters of the City of Fridley, hereby nominate / . //b "t r whose residence is 700 MWI i5 �►�, �,f ,for the office of Cj 7, Co u,4 c '/ ,to be voted for at the election to be held on the th day of November 2018, and we in ividually 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. Birth Pri d Full Name and Signature Address . Al Los VI � �� `1�� � �1�tv1�� ��- Lr►N� lue 114b It i(, '►S �` (j to 5'� 7/,4 Ayc +vtf �r✓w+ T-, it ,,.Q rV- being duly sworn, deposes and says, "I am the circulator of the foregoing petition paper containing si atures 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: (Please Print Name) This petition, if found insufficient by the City Clerk, shall be returned to_ at Fridley, Minnesota. I hereby indicate my willinto accept the office of if duly elected thereto. ^ C— d� ,,� ccc...yyy��� (Signator f Nominee) Subscribed and sworn to before me this a,J day of ,2018. =n� (Notary Public) I%AAAAAAAAAAAAAAAAAAAAAAAAAA^AAA,% 4.f,- 1 i mow Fridley City of Fridley Nomination Petition We,the undersigned, registered voters of the City of Fridley, hereby nominate�M / � t A-e -�r y whose residence is _:200 S,S:1S:f��1, �'f AI ,for the office of C` ' t� ,to be voted / for at the election to be held on the 6th day of November 2018, and we ind i�erti 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. Bitch Printed Full Name and Signature Address X1 796 Nt IM%jAAft4 L'I 49 13 I Ib 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 my name to appear on the ballot exactly as follows: (Please Print Name) This petition, if found insufficient by the City Clerk,shall be returned to_ at Fridley, Minnesota. I hereby indicat y willin to accept the office of if duly elected thereto. tTlyt 4% (Signa of Nominee) Subscribed and sworn to before me this A 5 day of ,2018. (Notary ublic) DEBRA A. a.�-ti, ,i : �5' Notary Put lio-F,,,j, cx a *commission Gsims,�z.� ,`s,��c0 Re..