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Statement for Public Disclosure <br />Applicant: <br />Address: <br />Taxpayer ID#: <br />Applicant proposes to enter into contract for the purchase or lease of land from the South <br />Bend Redevelopment Commission. Said land is more accurately described in Exhibit <br />'.A' . <br />2. Organizational Status of Applicant: <br />An individual <br />'- ! A corporation <br />C~ Anot-for-profit corporation or charitable institution <br />A partnership known as: <br />A business association or a joint venture known as: <br />^ A Federal, State or Local government or instrument thereof <br />^ Other (explain): <br />3. Organized and operating under the laws of <br />4. Date of Organization: <br />5. Names, addresses, and title of principal officers, investors, members or shareholders of <br />Applicant, as follows: (attach additional sheets if necessary) <br />a. CORPORATION: the officers, directors or trustees, and each stockholder <br />owning more than 10% of any class stock <br />b. NOT-FOR-PROFIT: the members who constitute the board of trustees or board <br />of directors or similar governing body <br />c. PARTNERSHIP: each partner, whether a general or limited partner, and the <br />nature and percent of interest <br />d. BUSINESS ASSOCIATION OR JOINT VENTURE: each participant and the <br />nature and percent of interest <br />7 <br />