Form Lq/07 - City Of Canfield Landlord Questionnaire (Page 2 of 2) in pdf

11. Owner's name and address:

If individual proprietorship

If corporate subsidiary give name and

give owner's name and address

address of parent company main office.

Name ___________________________________________ Name ________________________________________

Address _________________________________________ Address ______________________________________

City _______________ State ____ ZIP ________________ City _______________ State ____ ZIP ______________

12. If partnership, association, or other unincorporated joint business venture list names and address of partners if they

elect to pay tax on their proportionate shares:

Name

Address

City

State

ZIP

1. ________________________________________ _________________________ ______________ ____ __________

2. ________________________________________ _________________________ ______________ ____ __________

3. ________________________________________ _________________________ ______________ ____ __________

13. With reference to real estate properties located WITHIN the City does the business occupy, as tenant, real property

rented from others? _____ If yes, to whom is rent paid? (Give owner or agent and address.)

Name

Address

City

State

ZIP

1. ________________________________________ _________________________ ______________ ____ __________

2. ________________________________________ _________________________ ______________ ____ __________

14. You are required to provide us with the name and address of the individual or business renting or leasing the property. If

necessary, attach a list.

________________________________________________________________________________________________

15. Please note any supplemental information here or use as additional space for providing requested information.

________________________________________________________________________________________________

16. The information hereby submitted is true and correct:

Name (individual) ______________________________________ Company ___________________________________

Address ____________________________________________________ City ________________________________

State ______ ZIP _____________ Phone # ___________________ Ext. ____________

Signature _________________________________________________ Title ___________________________________

Date Signed ________________

LQ/07

Form Lq/07 - City Of Canfield Landlord Questionnaire Page 2