Laserfiche WebLink
Spri <br />-.P F 1' r f w P F. -com to remove the watermark <br />STOCKHOLDER DISCLOSURE CERTIFICATION <br />This Statement Shall Be Included with Bid Submission <br />1 certify that the list below contains the names and home addresses of all stockholders <br />holding 10% or more of the issued and outstanding stock of the undersigned. <br />OR <br />0 1 certify that no one stockholder owns 10% or more of the issued and outstanding stock of <br />the undersigned. <br />Check the box that represents the type of business organization: <br />0 Partnership OC;orporation Mole Proprietorship <br />13 Limited Partnership 0 Limited Liability Corporation Mimited Liability Partnership <br />0 Subchapter S Corporation <br />Sign and notarize the form below, and, if necessary, complete the stockholder list below. <br />Stockholders: <br />Name: A.H. Murphy <br />Name: <br />I lome Address: 1827 Earle Road, Charles Town, WV Home Address: <br />25414 <br />Name: <br />Home Address: <br />Name: <br />Home Address: <br />Name: <br />Home Address: <br />Name: <br />I tome Address: <br />G:IRFP's 20100roftsl5pringfield NJ 4.1.1011ntegroted library system 2010.doc <br />13 <br />Attachment number 3 <br />F -12 Page 229 <br />