Township Council Meeting — Packet

STOCKHOLDER DISCLOSURE CERTIFICATION Please Check One: I certify that the list below contains the names and home addresses of all stockholders holding 10% or more of the issued and outstanding stock of the undersigned ______. I certify that no one stockholder owns 10% or more of the issued and outstanding stock of the undersigned _____. PLEASE CHECK TYPE OF BUSINESS ORGANIZATION: Partnership ____ Limited Partnership Corporation ____ Sole Proprietorship ____ ____ Limited Liability Corp ____ Limited Liability Partnership ___ Subchapter S Corp ____ PLEASE CHECK APPROPRIATE BOXES AND SIGN BELOW: Stockholders: Name: _______________________________________________ Home Address: ________________________________________ _____________________________________________________ Name: ________________________________________________ Home Address: _________________________________________ ______________________________________________________ 46