Township Council Meeting — Packet

STATEMENT OF OWNERSHIP DISCLOSURE NJ.S.A. 52:25-24.2 (P.L. 1977, ¢.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: STCGLLING SECTS = ) bs a5 UEZLOALAN peg PaagTvTus AvE ALT O7IUY Organization Address: Part | Check the box that represents the type of business organization: Dsote Proprietorship (skip Parts Il and lil, execute certification in Part IV} Dnon-Prosit Corporation (skip Parts {I and Ill, execute certification in Part IV) oO For-Profit Corporation (any type} Limited Liability Company (LLC) Oo Partnership Oo Limited Partnership oO Limited Liability Partnership (LLP) oO Other (be specific): Part ll fa 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 oO No one stockholder in the corporation owns 10 percent or more of its stock, of any class, of 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 x se , Venera Cary BoerT6s Saf’| (SS PEHaTPTORS ACK A ape4yY i “uo VERY ALA VINCERT Vecl 54 MSS Dpoweter Ave ny a7ty