Form Boe-100-B (S1) - Statement Of Change In Control And Ownership Of Legal Entities Page 9
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10Schedule B continued
BOE-100-B (S3B) REV. 21 (1-12)
3. Cumulative Transfer of Original Co-owners' Interests:
a. Provide a description of the transfer(s) that cumulatively result in a transfer of more than 50 percent of the original co-owners'
interests in the filing legal entity since the date noted in question 1 on Schedule B (S3F).
b. Identify the date(s) and percentage interest(s) transferred by any original co-owner(s) and the name(s) of the current
owner(s).
DATE(S) OF
% INTEREST
% INTEREST
NAME OF ORIGINAL CO-OWNER(S)*
NAME OF CURRENT OWNER(S)**
TRANSFER
TRANSFERRED
HELD
TOTAL MUST EQUAL MORE THAN 50%
TOTAL MUST EQUAL 100%
* If any interest(s) is held by a trust, indicate whether the trust is revocable or irrevocable and identify the beneficiaries of the trust.
** Current owner(s) is a party(ies) that holds an ownership interest in the legal entity after the date of the last transfer.
4. Transfer Information: Complete all statements as they pertain to ownership interest of a legal entity(ies); not transfer of real
property interests.
YES
NO
This transfer is solely between spouses or registered domestic partners. If transfer was due to death, provide date
a.
of death:
This transfer of ownership interest was between parties (for example, a transfer into or out of a legal entity or a
b.
transfer between legal entities) in which the proportional ownership interest of the transferor(s) and transferee(s)
remain exactly the same before and after the transfer.
If you answered "yes" to item b listed above, you must attach additional documentation. (See Instructions for documentation
required).
STATE USE ONLY
RESULT/REASON CODE
ENTITY NAME
ENTITY ID NUMBER
CIO DATE
DATE ENTERED
Change in Ownership (66):
Exclusion Applies (88):
No Change in Ownership (99):
Other:
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