Form Cq/2010 - Contractors & Sub-Contractors Questionnaire Page 2
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217. Owner's name and address:
If individual proprietorship give owners
If corporate subsidiary give name & address of parent
Name & address.
company main office.
Name ________________________________________
Name ________________________________________
Address ______________________________________
Address ______________________________________
City __________________ State ____ ZIP ___________
City __________________ State ____ ZIP __________
18. If partnership, association, or other unincorporated joint business venture list names and addresses of partners if
they elect to pay tax on their proportionate shares:
Name
Address
City
State
ZIP
1. ______________________________ ________________________________ ____________ ____ ________
2. ______________________________ ________________________________ ____________ ____ ________
3. ______________________________ ________________________________ _____________ ____ _______
19. With reference to real estate properties located within the City does the business occupy, as tenant, real property
rented or leased from others? ___ If yes, to whom is rent paid? (Give owner or agent, address and phone #.)
Name
Address
City
State
ZIP
Phone #
1. _______________________ ___________________________ ____________ ____ _______ ____________
2. _______________________ ___________________________ ____________ ____ _______ ____________
20. If you are renting or leasing property to others, we require you to provide the name and address of the individual(s)
or business renting or leasing the property.
_____________________________________________________________________________________________
_____________________________________________________________________________________________
19. Please note any supplemental information here or use as additional space to provide requested information.
____________________________________________________________________________________________
____________________________________________________________________________________________
20. List other businesses you operate within the City of Canfield? __________________________________________
___________________________________________________________________________________________
21. The information hereby submitted is true and correct.
_________________________________________________ ___________ _______________________________
Company
Name (individual)
_____________________________________________
________________________ ____ ______________
Address
City
State
Zip
_______________________ _____________
Phone
Extension
_____________________________________ _________ ______________________________________
Signature
Date
Title
CQ/2010
PAGE 2
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Parent category: Financial