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Get Dlc4030 Officer Shareholder Disclosure Form - Com Ohio

FOR OFFICE USE ONLY http://www.com.ohio.gov/liqr OFFICER/ SHAREHOLDERS DISCLOSURE FORM (This form must accompany all applications of a corporate business entity) Name of Corporation DBA Name Permit Premises Address City, State Township, if in Unincorporated Area Tax Identification No. (TIN) Zip Code SECTION B. 1. Is stock publicly traded? If "YES", YES NO YES NO indicate exchange & Do NOT complete SECTION D. 2. Does any stockholder own 5% or more sh.

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