DEPARTMENT OF COMMUNITY DEVELOPMENT
DISCLOSURE OF INTEREST
If the property, which is the subject of the Application, is owned or leased by a CORPORATION, list the
Principal Stockholders and the percentage of stock owned by each. NOTE: Where the Principal Officers or
Stockholders consist of another Corporation(s), Trustee(s), Partnership(s) or other similar entities, further
disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the
ultimate ownership interest in the aforementioned entity.
_________________________________________________
Corporation Name
Name, Address and Office Percentage of stock
_________________________________________ __________________________________
_________________________________________ __________________________________
_________________________________________ __________________________________
If the property, which is the subject of the Application, is owned or leased by a TRUSTEE, list the Principal
Stockholders and the percentage of stock owned by each. NOTE: Where the Principal Officers or
Stockholders consist of another Corporation(s), Trustee(s), Partnership(s) or other similar entities, further
disclosure shall be required which discloses the identity of the individual(s) (natural persons) having the
ultimate ownership interest in the aforementioned entity.
_________________________________________________
Trust Name
Name, Address and Office Percentage of stock
_________________________________________ __________________________________
_________________________________________ __________________________________
_________________________________________ __________________________________
If the property, which is the subject of the Application, is owned or leased by a PARTNERSHIP or LIMITED
PARTNERSHIP, list the Principal Stockholders and the percentage of stock owned by each. NOTE: Where the
Principal Officers or Stockholders consist of another Corporation(s), Trustee(s), Partnership(s) or other similar
entities, further disclosure shall be required which discloses the identity of the individual(s) (natural persons)
having the ultimate ownership interest in the aforementioned entity.
_________________________________________________
Partnership or Limited Partnership Name
Name, Address and Office Percentage of stock
_________________________________________ __________________________________
_________________________________________ __________________________________
_________________________________________ __________________________________