Laserfiche WebLink
GENERAL INFORMATION <br />Page 8 <br /> <br />12(c) Of the above cost of assets acquired, state the amount that is provided by the person(s) investing <br /> in this business: (Attach supporting proof of the source of such money). <br /> <br />13. <br /> <br />Give full names, dates of birth, addresses, telephone numbers of all persons, other than the <br />applicant, who have any financial interest in the business, buildings, premises, fixtures, furniture, <br />or stock in trade. State the nature of the interest amount thereof, and the terms for payment or <br />other reimbursement: (This shall include, but not be limited to, any lessees, lessors, mortgagors, <br />lenders, lien holders, trustees, trustors, and persons who have co-signed notes or otherwise loaned, <br />pledged, or extended security for any indebtedness of the applicant.) <br /> <br />Full Name: DOB: <br /> (Last) (First) (Middle) <br />Residence Address: PH: <br /> <br />City/State/Zip: <br /> <br />Nature of Interest, etc.: <br /> <br />Full Name: DOB: <br /> (Last) (First) (Middle) <br />Residence Address: PH: <br /> <br />City/State/Zip: <br /> <br />Nature of Interest, etc.: <br /> <br />Full Name: DOB: <br /> (Last) (First) (Middle) <br />Residence Address: PH: <br /> <br />City/State/Zip: <br /> <br />Nature of Interest, etc.: <br /> <br /> <br />