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Doing Business Data Form - Land Use Actions - New York

Doing Business Data Form - Land Use Actions Form. This is a New York form and can be used in City Planning City Of New York New York Local County .
 Fillable pdf Last Modified 11/17/2008
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The City of New York Mayor's Office of Contract Services Doing Business Accountability Project For Office Use Agency: Application #: Doing Business Data Form: Land Use Actions Check one: General (GEN) Lease Acquisition (LES) A Doing Business Data Form must be completed by any land use applicant subject to the provisions of Local Law 34 of 2007 (see Q&A sheet for more information). Please either type responses directly into this fillable form or print answers by hand in black ink. For all submissions, please be sure to fill out the certification box on the last page, and include the completed Data Form as part of the land use application package. Submission of a complete and accurate form is required at the time of application filing and, where applicable, is required for the certification or referral for public review of any land use application subject to the provisions of Local Law 34 of 2007 (see 62 RCNY ยง 2-02(a) (1)). This Data Form requires information to be provided regarding the applicant, and if the applicant is a corporation or other entity, its principal officers, owners and senior managers. The name, employer and title of each person identified on the Data Form will be included in a public database of people who do business with the City of New York; no other information reported on this form will be disclosed to the public. Please contact the Doing Business Accountability Project at 212-788-8104 or DoingBusiness@cityhall.nyc.gov with any questions regarding the Data Form. Thank you for your cooperation. Section 1: Applicant Information Applicant Name: Applicant EIN/TIN: Applicant Filing Status (select one): Applicant has never completed a Doing Business Data Form. Fill out the entire form. Change from previous Data Form dated No Change from previous Data Form dated Applicant is a Non-Profit: Applicant Type: Yes No Joint Venture Other (specify): LLC Partnership (any type) . Fill out only those sections that have changed, . Skip to the bottom of the last page. and indicate the name of the persons who no longer hold positions with the applicant. Corporation (any type) Sole Proprietor Address: City: Phone : Email: Provide your e-mail address and/or fax number in order to receive notices regarding this form by e-mail or fax. State: Fax : ZIP: 09/24/2008 For information or assistance, call the Doing Business Accountability Project at 212-788-8104. Form A/LU American LegalNet, Inc. www.FormsWorkflow.com Doing Business Data Form EIN/TIN: Page 2 of 4 Section 2: Principal Officers Please fill in the required identification information for each officer listed below. If the applicant has no such officer or its equivalent, please check the "Position does not exist" box. If the applicant is filing a Change Data Form and the person listed is replacing someone who was previously disclosed, please check the "This person replaced" box and fill in the name of the person being replaced so his/her name can be removed from the Doing Business Database, and indicate the date that the change became effective. Chief Executive Officer (CEO) or equivalent officer This position does not exist The highest ranking officer or manager, such as the President, Executive Director, Sole Proprietor or Chairperson of the Board. First Name: Office Title: Employer (if not employed by applicant): Birth Date (mm/dd/yy): Home Address: This person replaced former CEO: on date: Home Phone #: MI: Last: Chief Financial Officer (CFO) or equivalent officer This position does not exist The highest ranking financial officer, such as the Treasurer, Comptroller, Financial Director or VP for Finance. First Name: Office Title: Employer (if not employed by applicant): Birth Date (mm/dd/yy): Home Address: This person replaced former CFO: on date: Home Phone #: MI: Last: Chief Operating Officer (COO) or equivalent officer This position does not exist The highest ranking operational officer, such as the Chief Planning Officer, Director of Operations or VP for Operations. First Name: MI: Last: Office Title: Employer (if not employed by applicant): Birth Date (mm/dd/yy): Home Address: This person replaced former COO: on date: Home Phone #: For information or assistance, call the Doing Business Accountability Project at 212-788-8104. American LegalNet, Inc. www.FormsWorkflow.com Doing Business Data Form EIN/TIN: Page 3 of 4 Section 3: Principal Owners Please fill in the required identification information for all individuals who, through stock shares, partnership agreements or other means, own or control 10% or more of the applicant. If no individual owners exist, please check the appropriate box below to indicate why and skip to the next page. If the applicant is owned by other business entities, those entities do not need to be listed. If an owner was identified on the previous page, fill in his/her name and write "See above." If the applicant is filing a Change Data Form, list any individuals who are no longer owners at the bottom of this page. If more space is needed, attach additional pages labeled "Additional Owners." There are no owners listed because (select one): The entity is not-for-profit Other (explain): There are no individual owners No individual owner holds 10% or more shares in the entity Principal Owners (who own or control 10% or more of the applicant): First Name: Office Title: Employer (if not employed by applicant): Birth Date (mm/dd/yy): Home Address: First Name: Office Title: Employer (if not employed by applicant): Birth Date (mm/dd/yy): Home Address: First Name: Office Title: Employer (if not employed by applicant): Birth Date (mm/dd/yy): Home Address: Home Phone #: MI: Last: Home Phone #: MI: Last: Home Phone #: MI: Last: Remove the following previously-reported Principal Owners: Name: Name: Name: Removal Date: Removal Date: Removal Date: For information or assistance, call the Doing Business Accountability Project at 212-788-8104. American LegalNet, Inc. www.FormsWorkflow.com Doing Business Data Form EIN/TIN: Section 4: Senior Managers Page 4 of 4 Please fill in the required identification information for all senior managers who oversee land use applications. Senior managers include anyone who, either by title or duties, has substantial discretion and high-level oversight regarding the administration of such land use applications, not limited to the land use application for which this form is being filed. At least one senior manager must be listed, or the Data Form will be considered incomplete.
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