160-25 Exhibit.pdf

STATEMENT OF OWNERSHIP DISCLOSURE N.J.S.A. 52:25-24.2 (P.L. 1977, c.33, as amended by P.L. 2016, c.43) This statement shall be completed, certified to, and included with all bid and proposal submissions. Failure to submit the required information is cause for automatic rejection of the bid or proposal. Name of Organization: _ Millennium Strategies Organization Address: 60 Columbia Road, Building B, Suite 230, Morristown, NJ, 07960 Part I Check the box that represents the type of business organization: Dsoie Proprietorship (skip Parts II and III, execute certification in Part IV) Dnon-rrofit Corporation (skip Parts | Land lll, execute certification in Part IV) O Partnership. Oo Limited P: oO Other (be specific): Part I The list below contains the names and addresses of all stockholders in the corporation who own 10 percent or more of its stock, of any class, or of all individual partners in the partnership who own a 10 percent or greater interest therein, or of all members in the limited liability company who own a 10 percent or greater interest therein, as the case may be. (COMPLETE THE LIST BELOW IN THIS SECTION) OR O No one stockholder in the corporation owns 10 percent or more of its stock, of any class, or no individual partner in the partnership owns a 10 percent or greater interest therein, or no member in the limited liability company owns a 10 percent or greater interest therein, as the case may be. (SKIP TO PART IV) Please attach additional sheets if more space is needed): Name of Individual or Business Entity Address Edward Farmer 1803 Middlebrook Road, Bound Brook, NJ, 08805 Susan Scavone 165 Alexander Avenue, Nutley, NJ, 07110 Part III DISCLOSURE OF 10% OR GREATER OWNERSHIP IN THE STOCKHOLDERS, PARTNERS OR LLC MEMBERS LISTED IN PART II