ATTACHMENT B
Public Integrity
Disclosure Form
PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
1. Name of Entity
2. Address of Entity (Principal Place of Business)
3. Local or California Address (if different than #2)
4. State where Entity is Registered with Secretary of State If othe
r than California, is the Entity also registered in California? Yes No
5. Type of Entity
Corporation Limited Liability Company Partnership Trust Other (please specify)
6. Officers, Directors, Members, Managers, Tru stees, Other F iduciaries (please specify) Note: If any response is not a natural person, please i dentify all off icers, directors, members, managers and other fiduciaries for the member, manager, trust, or other entity
________________________ Officer Director Member Manager [name] Gener al Partner Limited Partner
Othe r ___________________________
_______________________________ Officer Director Member Manager [name] General Partner Limited Partner
Ot her __________________________
________________________
________ Officer Director Member Manager
[name] General Partner Limited Partner
Other __________________________
Neighborhood Partnership Housing Services, Inc.
9551 Pittsburgh Ave., Rancho Cucamonga, CA 91730
California
Clemente Mojica
Solon Escobar
Jesse Ibarra
x
x
x
x