Fillable Sba Form 1010-Anc - Alaska Native Corporation Information printable pdf download

Sba Form 1010-Anc - Alaska Native Corporation Information

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OMB Approval No. 3245-0331

Expiration Date: 04/30/2017

Alaska Native Corporation Information

The Alaska Native Corporation that owns the applicant business concern

must complete this form. 13 C.F.R. § 124.109(a).

YOUR SIGNATURE ON THIS FORM INDICATES THAT YOU FULLY UNDERSTAND

ALL QUESTIONS AND CERTIFIES THAT ALL RESPONSES AND DOCUMENTS

ARE TRUTHFUL AND ACCURATE.

Name of Applicant Business Concern (include any trade or d.b.a. names):

__________________________________________________________________________

Name of Parent Alaska Native Corporation (ANC):

_________________________________________

Note: An ANC means any Regional Corporation, Village Corporation, Urban Corporation, or

Group Corporation organized under the laws of the State of Alaska in accordance with the

Alaska Native Claims Settlement Act, as amended 43 U.S.C. 1601, et seq. 13 C.F.R. § 124.3.

Telephone: (

)____________________

Fax: (

)_________________________

Address:

_______________________________________________________________________

City: _____________________ County: _____________ State: ______________ Zip:

______________

E-mail: __________________________________ @ ___________

Mailing Address (if different from above)

Address:

_____________________________________________________________________

City: _____________________ State: ______________ Zip: ______________

ANC percent ownership of applicant business concern: ___________

Please answer the following questions and provide the required documents:

1. Does the ANC or subsidiary of the ANC own 50% or more of another

[ ]Yes

[ ]No

business concern other than the applicant business concern? If yes,

identify the names of any other business concern(s), the primary NAICS

code of the other business concern(s), and which (if any) of the other

business concerns have ever participated in the 8(a) BD Program.

2. Does the ANC own the applicant business concern directly (rather than

[ ]Yes

[ ]No

through a subsidiary)?

Sba Form 1010-Anc - Alaska Native Corporation Information

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