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7 <br />Statement for Public Disclosure <br />Applicant: <br />Address: <br />Taxpayer ID#: <br />1. Applicant proposes to enter into contract for the purchase or lease of land from the SouthBend Redevelopment Commission. Said land is more accurately described in Exhibit“A”. <br />2. Organizational Status of Applicant: <br /> An individual <br /> A corporation <br /> A not-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 ofApplicant, as follows: (attach additional sheets if necessary) <br />a.CORPORATION: the officers, directors or trustees, and each stockholderowning more than 10% of any class stock <br />b.NOT-FOR-PROFIT: the members who constitute the board of trustees or boardof directors or similar governing body <br />c. PARTNERSHIP: each partner, whether a general or limited partner, and thenature and percent of interest <br />d.BUSINESS ASSOCIATION OR JOINT VENTURE: each participant and thenature and percent of interest