1999-06-01_GENERAL DOCUMENTS - C1981048 ‎(4)‎

• Permit No: C1981048
• IBM Index Class Name: General Documents
• Doc Date: 6/1/1999
• Doc Name: PKA-9-440
• From: DRMS
• To: Sue Grisawold
• Permit Index Doc Type: Reclamation Projects
• Media Type: D
• Archive: No

7. If the contractor' s legal structure is other than a sole
proprietorship, provide all the information set forth below
for every officer, general partner, shareholder (10% or
greater voting stock) , and director or any other person or
entity who owns or controls the applicant.
778.13 (c) (1) (2) (3)
773 .5
Name NO�. % of ownership b
Mailin Address �u �a
City Ftl + tate (rl� Zip �g
Phoneg� Title Date Position Assumed
SSN �^^ d 1 %��� EIN
% of ownership �D
Name
Mailing Addre s
Cityj State Zip ,
Phone$ Title Date Position Assumed
SSN :�c� EIN
Name
of ownership ��d
Mailing dress '
City V State Zip 0
Phone ( Title � V Date Position Assumed ' 9
SSN EIN
of ownership
Name
Mailing Address
City State Zip
Phone Title Date Position Assumed
SSN EIN
Name % of ownership
Mailing Address
City State Zip
Phone Title __ Date Position Assumed
SSN EIN
Name % of ownership
Mailing Address
City State Zip
Phone Title Date Position Assumed
SSN EIN
Name % of Ownership
Mailing Address
City State Zip
Phone Title Date Position Assumed
SSN EIN
i