Form Mld-1 - Uniform Notification Form For Multi-Level Distribution Companies With A Montana Participant Page 2
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4Schedule A of
Form MLD
Name of Multi-Level Distribution Company:
Date:
1. List below all individuals who have direct responsibility for the management of the
Multi-Level Distribution Company. Also include each beneficial owner having the power
to vote or dispose of 10% or more of a class of equity securities of the Company:
Full legal name:
Title :
Date title acquired:
SSN AND Date of Birth & State of Residence Mailing address:
(city)
(State)
(Zip)
Full legal name:
Title :
Date title acquired:
SSN AND Date of Birth & State of Residence Mailing address:
(city)
(State)
(Zip)
Full legal name:
Title :
Date title acquired:
SSN AND Date of Birth & State of Residence Mailing address:
(city)
(State)
(Zip)
Full legal name:
Title :
Date title acquired:
SSN AND Date of Birth & State of Residence Mailing address:
(city)
(State)
(Zip)
Full legal name:
Title :
Date title acquired:
SSN AND Date of Birth & State of Residence Mailing address:
(city)
(State)
(Zip)
Full legal name:
Title :
Date title acquired:
SSN AND Date of Birth & State of Residence Mailing address:
(city)
(State)
(Zip)
Orig. 5/04
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