HomeMy WebLinkAboutRP 94-03; Carlsbad Mineral Springs Spa; Redevelopment Permits (RP) (5)Citv of Carlsbad
Plannina Department
DISCLOSURE STATEMENT
APPLlCAf^ S STATEMENT OF DISCLOSURE OF CERTAIN OWNERSHIP INTERESTS ON ALL APPLICATIONS WHICH WILL REQUIRE
DlSCRmONARY ACTION ON THE PART OFTHE CITY COUNCIL OR ANY APPOINTED BOARD. COMMISSION OR COMMfTTEE.
[Please Print)
The foliowing information must be disclosed:
1 Applicant
List the 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 prpperty involved.
If any person identified pursuant to (1) or (2) above is a corporation or partnership, list the names and
addresses of all individuals owning more than 10% of the shares in the corporation or owning any partnership
interest in the partnership, v
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If any person identified pursuant to (1) or (2) above is a non-profit organization or a trust, list the names and
addresses of any person serving as officer or director of the non-profit organization or as trustee or beneficiary
of the trust.
FRM00013 8/90
2075 Las Palmas Orive • Carlsbad. California 92009-4859 • (619) 438-1161
Disclosure Statement
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Page 2
Have you had more than $250 worth of business transacted with any member of City staff. Boards
Commissions. Committees and Council within the past twelve months?
Yes No ^2^^ If yes, please indicate person{s)
Person is defined AS: 'Any individual, firm, copartnerjhip. joint vantura. association, social club. Irat*rnal organaation, corpof ation, astata trust,
receiver, syndicate, this and any oth**-county, crty and county, crty municipalrty. district or othar political subdivision, or any olhar grov-p or
combination acting as a unrt*
(NOTE: ttach additional pages as necessary.)
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Print or type nime of owner
igrfm^e of applicantydate
Print or type name of applicant
FRM00013 8/90