DISCLOSURE FORM
(Form 3 of 5)
Project Title: DVDT & 2000 Sebastopol Road, Santa Rosa, CA 95407 (Include site address)
Please provide the name of each individual, partnership, corporation, LLC, or trust who has an interest in the proposed land use action. Include the names of all applicants, developers, property owners, and each person or entity that holds an option on the property.
Individuals:
Partnerships:
Corporations:
LLCs:
Trusts:
Identify all individuals
Identify all general and limited partners
Identify all shareholders owning 10% or more of the stock and all officers and directors (unless the corporation is listed on any major stock exchange, in which case only the identity of the exchange must be listed.
Identify all members, managers, partners, officers and directors.
Identify all trustees and beneficiaries.
Option Holders: Identify all holders of options on the real property.
Full Name: Address:
Luz Navarro de Martinez 2972 Park Meadow Drive, Santa Rosa CA 95407 In addition, please identify the name of each civil engineer, architect, and consultant for the project.
Full Name: Address:
Additional names and addresses attached: Yes ■ No
The above information shall be promptly updated by the applicant to reflect any change that occurs prior to final action.
I certify that the above information is true and correct: 5/20/23 Applicant Date
Jim Fain 15 Third Street, Santa Rosa CA 95401
Jon Olin 15 Third Street, Santa Rosa CA 95401
Cindy Omoth 15 Third Street, Santa Rosa CA 95401
Allison Jaromin 490 Mendocino Ave #201, Santa Rosa CA 95401 Dalene J. Whitlock 490 Mendocino Ave #201, Santa Rosa CA 95401 City of Santa Rosa
Planning & Economic
Development Department
May 22, 2023
RECEIVED
Attachment 1