Form Ap-138 - Texas Coin-Operated Machine Ownership Statement
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2AP-138
(Rev.1-04/9)
TEXAS COIN-OPERATED MACHINE
OWNERSHIP STATEMENT
You have certain rights under Ch. 559, Government Code, to review,
request, and correct information we have on file about you. Contact us at
NOTE: This statement must be completed and submitted with
the address or toll-free number listed on this statement.
your application or request for change of owner information.
Entity name and mailing address
PUBLIC INFORMATION - Release of information
on this form in response to a public information
request will be governed by the Public Information
Act, Chapter 552, Government Code. In
accordance with Section 2153.101, Occupations
Code, after a license is issued, the Ownership
Statement is a public record.
GENERAL INSTRUCTIONS
WHO MUST SUBMIT THIS STATEMENT
• A business applying for a license or registration certificate MUST list ALL
You must complete this statement to provide additional information
owners of the business and indicate their percentage of ownership of the
requested if:
business.
• you are applying for a General Business License, Import License, Repair
• All corporate stockholders owning 10% or more of the corporation’s stock
License, or Registration Certificate;
must be listed.
• you are adding or changing owner information.
• Complete all the information requested for each name listed.
• TYPE or PRINT
• Attach additional sheets, if necessary.
Legal name of entity
Taxpayer number
Nature of business entity (if not sole owner):
Texas registered limited liability partnership (PR)
Texas profit corporation (CT)
Estate (ES)
Non-Texas registered limited liability partnership (PS)
Texas nonprofit corporation (CN)
Professional corporation (CP)
General partnership (PG)
Non-Texas limited liability company (CI)
Professional association (AP)
Limited partnership (PL or PF)
Non-Texas profit corporation (CF)
Trust (FM)
Texas limited liability company (CL)
Non-Texas nonprofit corporation (CM)
Other (Describe)
Name (Last, first, middle initial)
Daytime phone (Area code and number)
Home address (Street)
City
State
ZIP Code
Position (Check all applicable boxes)
Percentage of ownership or
corporate stock held
%
Sole owner
Partner
Director
Officer
Corporate stockholder
Name (Last, first, middle initial)
Daytime phone (Area code and number)
Home address (Street)
City
State
ZIP Code
Position (Check all applicable boxes)
Percentage of ownership or
corporate stock held
%
Partner
Director
Officer
Corporate stockholder
Name (Last, first, middle initial)
Daytime phone (Area code and number)
Home address (Street)
City
State
ZIP Code
Position (Check all applicable boxes)
Percentage of ownership or
corporate stock held
%
Partner
Director
Officer
Corporate stockholder
Name (Last, first, middle initial)
Daytime phone (Area code and number)
Home address (Street)
City
State
ZIP Code
Position (Check all applicable boxes)
Percentage of ownership or
corporate stock held
%
Partner
Director
Officer
Corporate stockholder
CONTINUED ON OTHER SIDE
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