Township Council Meeting — Packet

STATEMENT OF OWNERSHIP DISCLOSURE N.J.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 informati ion of the bid or proposal. 416 E. CENTRAL BLVD. Name of Organization: tr : ib PALISADES PARK, NJ 07650 Part I Check the box that represents the type of business organization: Organization Address: Dsoie Proprietorship (skip Parts IT and III, execute certification in Part 1V) Profit Corporation (skip Parts IT and III, execute certification in Part IV) r-Profit Corporation (any type) Diimitea Liability Company (LLC) Partnership Oo Limited Partnership oO Limited Liability Partnership (LLP) 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 Oo 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 WZ Cavan VA. Saul ® pguaho Ailendale aS Sage Danna 623 Taylan Aw Caving agi ae Ovadil, A. P-23