Montana Form Lotapp 5003 - Lottery Application Page 2
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1
2Corporate Statement
The stockholders of the corporation are:
Social Security
Date
Number
Name
Address
Number
of Birth
of Shares
The officers and directors of the corporation are:
Name
Address
Title
I_____________________________________________declare under penalty of false swearing that the information
Name
on this corporate statement is true and complete.
Date_____________
Attach additional pages if necessary
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Parent category: Financial