CC PACKET 01252005 - Laserfiche WebLink

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CORPORA`S'ION OR ASSOCIATION �7 (To be filled out by as Officer of the Corporation or Assooiatimr) List thename or corporation or association, St. Anthony address and phone number and home office address Name State of Inc. or Assoc. Fridley address Phone number ----- - -------------- — ...... ------ - -- H.ome office address Phone number List the f ll names, home addresses,phone numbers rd date -of bir h of all officers of said corporation or association. President Full name .P rst oiddle Last t Home Address: Phone Number Home, Wo.k Date of Birth -- ---------...----._..— ---- .._._..----- Vice -President Full ,name First Llome Address: Phone.Nunilicir r Da,e of Birth Secretary Foil nai%e Piisf (-Tome A.ddross: Phone Number _ Harr Date of Birth Treasurer Full name Home Address: Phone Number Date of Birth Fist Middle Middle Middle Last Last Last List the full names, home addresses and phone numbers of all persons who singly or together with their spouse, parents, brothers, sisters or child en, own or control an interest in said corporation or association in excess of 5% and date -of birth. Fullname Fist Middle Last Home Address: _ Phone Number home Work Interest Date of Birth Full name Home Address: Phone Nmnber Interest Date of Birth Full name Home Address: Phone Number Interest Date of Birth Punt Middle Last home Work --......_.— First Middlc Home Work Last