Names and addresses of all persons listed as Owners, Trustees and officers of the corporations
and all persons in actual charge of the operations of the business. (Additional Sheets may be
attached).
Name: __________________________________________________________
Title: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
Name: __________________________________________________________
Title: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________
List the name(s) and address (es) of any other Hotel or Motel owned, operated or managed by the
applicant, permitted, or any officer or trustee listed above.
Name: __________________________________________________________
Title: __________________________________________________________
Address: __________________________________________________________
__________________________________________________________
Telephone Number: __________________________________________________________