Application For License Page 2
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46.a. List names, titles and addresses of all corporate officers of your business
(attach additional pages if necessary) :
Name and Title
Mailing Address
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6.b. List names, titles and addresses of all directors of your business
(attach additional pages if necessary) :
Name and Title
Mailing Address
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6.c. List names, titles and addresses of all general partners of your business
(attach additional pages if necessary) :
Name and Title
Mailing Address
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2
6.d. List names, titles and addresses of all shareholders* with controlling interests in your business
(attach additional pages if necessary) :
Name and Title
Mailing Address
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*if < 15 shareholders, list all; if more than 15 shareholders, list those with > 5% of ownership
6.e. List names, titles and addresses of all principal officers of your business
(attach additional pages if necessary) :
Name and Title
Mailing Address
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7. Has the applicant, or any officer or director thereof, been convicted of a felony with the past 10 years?
Yes
No
If yes, explain :
Page 2 of 5
Office of the Navajo Tax Commission
P.O. Box 1903, Window Rock, AZ 86515
FET:
Ph: (928) 871-6681; Fax: (928) 871-7608
Application for License
Revised: 2/12/2002
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Parent category: Business