Officers' Interrogatory Form (Fillable)

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OFFICERS' INTERROGATORY
This interrogatory must be completed by each officer or other individual having a right to participate in the management of the
applicant's business in the State of Nebraska. If additional forms are needed, copies may be made.
_____________________________________________________________
___________________________________
Name of Officer
Title
______________________________________________________________________________________________________
Residence Address, City, State, Zip
List the places where you have been engaged in any kind of business or vocation accounting for the entire
period since you left school or college. If additional space is needed, attach a separate sheet to application.
Nature of Business ______________________________________________________________________________________
Employer ______________________________________________________________________________________________
Address ________________________________________________________________________________________________
Position held ____________________________________________________
From ____________
To ____________
Nature of Business ______________________________________________________________________________________
Employer ______________________________________________________________________________________________
Address ________________________________________________________________________________________________
Position held ____________________________________________________
From ____________
To ____________
Nature of Business ______________________________________________________________________________________
Employer ______________________________________________________________________________________________
Address ________________________________________________________________________________________________
Position held ____________________________________________________
From ____________
To ____________
Nature of Business ______________________________________________________________________________________
Employer ______________________________________________________________________________________________
Address ________________________________________________________________________________________________
Position held _____________________________________________________
From ____________
To ____________
Nature of Business ______________________________________________________________________________________
Employer ______________________________________________________________________________________________
Address ________________________________________________________________________________________________
Position held _____________________________________________________
From ____________
To ____________
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