Disclosure Pursuant to the
City of Pasadena Taxpayer Protection Amendment
Pasadena City Charter, Article XVII
Contractor/Organization hereby discloses its tmstees, directors, partners, officers, and those with more than 10% equity, participation, or revenue interest in Contractor/Organization, as follows:
(If printing, please print legibly. Use additional sheets as necessary.)
1. Contractor/Organization Name:r\ I ^ /" 1
V^C •- p-c-^^) , /./, ^.r-..S<^ ^ l^, ( ,
2. Type of Entity: <r /.,.-^
a non-govemment D nonprofit 501 (c)(3), (4), or (6)
3. Name(s) of trustees, directors, partners, officers of Contractor/Organization:
P^- 9^>ve£x.
1^'
c^^.\ ^-^^•.•^^- ^(-><:-.'"I"? <--JJ: •
4. Names of those with more than a 10% equity, participation or revenue interest in Contractor/Organization:
P^A D.^V'i^--.,
CKr..^ V^.^
t-y
=b-
Prepared by: ( ,\'\('•-'•-) P^&k-
Title: Pc-o-."^^}
Phone:
Date:
-7; ci^^i^^LU_L
6/./^6
Rev.07.10.2007