HomeMy WebLinkAboutCUP 250B; PALOMAR DELI; Conditional Use Permit (CUP)-'Cit of <trarlsbad
DISCLOSURE STATEMENT
APPLICANTS STATEMENT OF DISCLOSURE OF CERTAIN OWNERSHIP INTERESTS ON ALL APPLICATIONS
WHICH WILL REQUIRE DISCRETIONARY ACTION ON THE PART OF THE CITY COUNCIL. OR ANY APPOINTED
BOARD. COMMISSION OR COMMITTEE.
(Please Print)
The following information must be disclosed:
1 . Applicant
2.
3.
4.
~ names and addresses of all persons having a financial interest in the application.
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Owner
List the names and addresses of all persons having any ownership interest in the properfy }jvolved.
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If any person identified pursuant to (1) or (2) above is a corporation or partnership, list the names ar.
addresses of all individuals owning more than 10% of the shares in the corporation or owning any partnersh,
interest in the partnership.
If any parson identified pursuant to (1) or (2) above is a non-profit organization or a trust, list the names anc
addresses of any parson serving u officer or director of the non-profit organization or as trustee or beneficiar
of the trust. · · ·
(Over)
Disclosure Statement Page 2
s. Have you had more than 5250 worth of business transacted with any ~ember of City staff, Boar:s
Commissions, Committees and Council within the past twelve months?
Yes_ No J::::::lf yes, please indicate person(s). __________________ _
Person is defined as: •Any individual, firm, copattnership, joint venture, association, social club, fraternal
organiZation, corpor•ion •. estate, trust. receiver, syndicate, lhia and any other county, city and county, city
municipality, district or other political subdivision. or any other group or combination acting as a unit.'
(NOTE: Attach additional pages as necessary.)
Signature of applicant/date
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Print or type name of owner Print or type name of applicant