CC PACKET 09272005 - Laserfiche WebLink

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M Name and address of former owner: NEW CONSTRUCTION Date purchased: Amount of down payment: Who currently holds the mortgage- name and address Term of mortgage: Rate of interest on mortgage: State monthly payment at which the mortgage and/or contract for deed is being Iigtudated: Ptnchase price: --------�._—..-- Amourn of Contract for Who ctnrently holds contract for deed- name and address: Terms of Contract for Deed: Rate of interest on Contact for Deed: Are the payments on the mortgage and/or contact for deed up to date? —Yes _ No State the amount of the urvesiment that the applicant has in the business premises,tuzes, furnihn'e, stock i7 Lade, etc. (Attach supporting proof of the soiree of such money) Give the full names, date -of -birth; addresses, tclephonc numbers of all persons, other than tlnc applicant, who have any financial interest in the 6usaness, buildings, premises, futures,ftrrniture, or stock in trade. State the naCare otzei , �.nnterest arnouttthereof, and fine terns for payment for or other rehnbursemenf. ('l'6is shall include, but not be limited To, any lessees, lessors, mortgagors, lenders, lien holders, testees, ixastors and persons who have co-signed notes or otherwise loaned, ptedgsl, or extended security for any indebU'dness of the applicant.) A release form is necessary for all persons who have fiwaneial interest in the business. Ful] Name:: First Middlo T—sL DOB Address Phone number: Work: Nature of interest, etc. Full Name::— gust hfiddlc Czst DOB Address: Phone number Nature of interest, etc.Full —~ Name:: hist Middlo Iain DOB Address: --- ._ ----- Phone Lumber -' ----� fIomc: Nature of interest, etc. ----- ._ If this Application is for premises either planned or under construction or undergoing substantial alteration, the by a set of plans showing the design of the proposed premises to be application shall be accompanied preliminary licensed.