Laserfiche WebLink
,.................. <br /> — -- ----- <br /> ^^�1 11 - <br /> IF CLAIMING CLASS C - O'I'IIF.R BUSINESS,CIIECK THIS i3l X AND COMPLLT}:'T}i}s FOLLOWING. Ii <br /> I A. CLAIMANT'S BUSINESS NAME TB. CLAIMANT'S BUSINESS D!I SCRIPTION i C.DATES OF OPERATION: <br /> —-- FROM TO: <br /> D.PRINCIPAL BUSINESS ADDRESS <br /> II �� <br /> E. <br /> IS THE PRINCIPAL OFFICE LOCATED IN CALIFORNIA? ' — YES NO <br /> ARE ALL OFFICERS/OWNERS OF THIS BUSINESS DOMICILED IN CALIFORNIA? YES NO <br /> IS THIS BUSINESS INDEPENDENTLY OWNED AND OPERATED? — YES NO <br /> IS THIS BUSINESS DOMINANT STATEWIDE IN ITS FIELD OF OPERATIONS? ! YES �� NO <br /> _— <br /> F. TYPE OF OWNERSHIP <br /> SOLE PROPR!ETOR PARTNERSHIP CORPORATION I OTHER-Please Scecity: <br /> - - <br /> G.AFFILIATED COMPANIES <br /> NAME: LOCATION: RELAT!ONSHIP: j <br /> i1! — ------ -- , ? <br /> 1---- ----- — it <br /> TOTAL NUMBER OF EMPLOYEES (Inciuding all a;•filiaies): <br /> i <br /> NOTE: DC:'CUMENTAT?C?°: SU?POR'?i•9G THE NUMQER OF EMPLOYEES 6E?A:.^-. CLAIMED 169:,Y BE REQUIRED. <br /> t <br /> Mr 5 .'i'.s�T * 4i:.3t't «ei [x �'#w.. .. <br /> IFC-A.I'+IING CUSS C - LOCAL GOVERNMENTtd-ENTITIES AND'ICNPitiOFTT ORGANIZATIONS, CIHECK <br /> I THIS BOX AND COMPLETE THE FOLLOWING: <br /> A. CLAIMANT STATUS <br /> LOCAL DISTRICT. II NCtiF=0F1T ORGANIZATION <br /> — yy 7YFE(i.e.Schoo!.Fire) <br /> TOTAL NUMBER OF EMPLOYEES: <br /> ( � u <br /> NOTE: DOCUMENTATION SUPPCR+ING !HE NUMBER OF EMPLOYEESI BEING CLAIMED MAY BE REQUIRED. <br /> -- , <br /> . .... . .. . ...:: <br /> ---_ .—_ TF C1_4IA:ING CLASS D - ------- � II �� , <br /> ALL OMER TANK O VNERS AIND/OR OPERA a ORS,CIU.CK'MIS BOX. <br /> NO FURY 1ER PRIORI T Y CLASS 1NFORMA'TION IS REQUIRED. <br /> it I <br /> ,REvISED i;ya) (SEE FACING PAGE FOR INSTRUCTIONS) PAGE e <br /> i <br />�I <br />