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<br /> <br /> <br />778.13 (c) (1) (2) (3) <br />773.5 <br />Name 6 of Ownership <br />Mailing Address <br />City State Zip <br />Zip <br />_ Date Position Assumed <br />EIN <br />Name 6 of Ownership <br />Mailing Address <br />City State Zip <br />Phone Title Date Position Assumed <br />SSN EIN <br />7. If the contractor's legal structure is other than a sole <br />proprietorship, provide all the information set forth below <br />for every officer, general partner, shareholder (106 or <br />greater voting stock), and director or any other person or <br />entity who owns or controls the applicant. <br />Phone Title Date Position Ass <br />SSN EIN <br />Name <br />Mailing Address <br />City State Z <br />Phone Title Date Position <br />SSN EIN <br />Name <br />Mailing Address <br />City State <br />Phone Title <br />SSN <br />Name <br />Mailing Address <br />City State <br />Phone Title _ <br />SSN <br />Zip <br />Date Position Assumed <br />EIN <br /> <br />6 of Ownership <br />Assumed <br />Name <br />Mailing Address <br />City State <br />Phone Title Date <br />SSN EIN <br />Name <br />Mailing Address <br />City <br />Phone Title <br />SSN <br />$ of Ownership <br />6 of Ownership <br />~ of Ownership <br />Assumed <br />~ of Ownership <br />Zip <br />_ Date Position <br />EIN <br />Assumed <br />