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6. Names, addresses, and the nature and percent of interest of each person or entity (not <br />named in Item 5) who has a beneficial interest in any of the shareholders or investors <br />named in Item 5 which gives such person or entity more than a computed 10% <br />interest in the Applicant (for example, more than 20% of the stock in a corporation <br />which holds 50% of the stock of the Applicant; or more than 50% of the stock in a <br />corporation which holds 20% of the stock of the Applicant). <br />Name & Address <br />Title and nature and percent of interest <br />7. Names of officers and directors, or trustees of any corporation or firm listed under <br />Item 5 or Item 6 above. <br />Name & Address <br />• O,h T /pia <br />Title and nature and percent of interest <br />So,mes Seoie f'a✓'y <br />Z2 7 S. Ma:., Sfi�eef� Ve. tac <br />so�ftl ISer.�(,Zr✓ Y�olvo/ <br />Certification <br />I (We), ,ok ,, T /�/� a: �- Certify that this Statement for Public <br />Disclosure is true and correct to the best of my (our) knowledge and belief. <br />Title <br />(L.I //l <br />Date <br />Name <br />Signature <br />Title <br />Date <br />(if the Applicant Is an individual, this statement should be signed by such Individual, If a partnership, it should be <br />signed by one of the partners; if a corporation or other entity, it should be signed by one of its chief officers <br />having knowledge of the facts required by this statement.) <br />48 <br />