Disclosure Pursuant to the
City of Pasadena Taxpayer Protection Amendment
Pasadena City Charter, Article XVII
Contractor/'Organization hereby discloses its trustees, directors, partners, officers, and those with more than 10% equity, participation, or revenue interest in Contractor/Organization, as follows:
(If printing, please prinl legibly. Use additional sheets as necessary'.)
1. Contractor/Organization Name: , /, ' ,
?S{>xinael^-krt(:?s> O/Y/ /t&
1 2. Type o^F Entity:
'non-govemment a nonprofit 501(c)(3), (4), or (6)
^. Name(s) of trustees, directors, partners, officers ot'Contractor/Organization:
bw^ ft-7I^n^s ^^\e pf^^'ie^r
4. Naines of those with more than a 10% equity, participation or revenue interest in Contractor/Organization:
Prepared by: (V?n?S^J^^4/
:_l/p Title:
Phone:
Date:
cilis ~1icl ^/7^^
I 1^1-Z3I
Rev.07.10.2007