Personal Information Questionaire Form Page 13
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18LLC, CORPORATE, OR PROFESSIONAL INTERESTS
BUY/
TYPE
SELL
NAME OF CORPORATION
OF
AGREE-
PERCENT
OR COMPANY
ENTITY
MENT?
OWNED
OWNER
VALUE
$
______%
______%
______%
______%
Total: $_________________
SOLE PROPRIETORSHIP BUSINESS INTERESTS
NAME OF CORPORATION
OR COMPANY
DESCRIPTION OF BUSINESS
OWNER
VALUE
$
Total: $_________________
12
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