Business And Professional Questionnaire Form Page 2
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210.
Type of ownership check which:
____Non-Profit Corporation
____Individual Proprietorship (Complete 11A)
____Corporation (Complete 11B)
____Partnership (Complete 11C)
11.
Owner’s name and address.
(a) If Individual proprietorship, give owner’s name social security number and address:
Name: ________________________________
Social Security No.: _____________________
Street Address: _________________________
City _____________ State _____ Zip _______
(b) If corporate subsidiary, give name and address of parent company main office:
Name: ________________________________
Federal I.D. No.: _______________________
Street Address: _________________________
City _____________ State _____ Zip _______
(c) If partnership, association, or other uncorporated joint business venture, list names and address of
partners, association, or members.
Name
SS# or Fed ID #
Street Address
City
State Zip
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
Note: Throughout this questionnaire, wherever listings are requested – attach separate list of sufficient
spaces have not been provided.
12.
With reference to real estate properties located within the City on Mansfield:
(a) Does the business occupy, as a tenant, real property in Mansfield rented from others?
If so, to whom is rent paid: (Give owner, if known, otherwise his agent.) ____Yes ____No
Name
SS# or Fed ID #
Street Address
City
State Zip
___________________________________________________________________________
13.
Do you operate any other business within the City of Mansfield? ____Yes ____No
Note: Other business includes rental properties rented to others.
If you do, List those located within the City:
___________________________________________________________________________
___________________________________________________________________________
So that further correspondence will not be necessary, we ask your cooperation in filing this form promptly.
THANK YOU
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Parent category: Financial