John Buyse, Planning Commission
City of Fridley
Public Disclosure Statement
By Members of Advisory Commissions
Kpio!Cvztf1201603135
Name:Date
Qmboojoh!Dpnnjttjpofs
Position Title:
Pursuantto Chapter 106of 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 106, 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 toreal 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 106, 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, AddressFinancial InterestPersonal Interest
Partnership, Etc.
(useadditional 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)
I do swear (or affirm) that this report is a full and true statement pursuant to Chapter 106of the Fridley City
Code.
1201603135
________________________________________________________________________
SignatureDate
This statement must be filed upon appointment or reappointment to an advisory committee or material
changes in financial interest while on an advisory committee.Please submit a signed Public DisclosureForm
to the City Clerk’s Office. Thank you.