Form Date: 8/9/07 Page 1 of 1
CITY OF VISALIA
Disclosure Contractors and Consultants
NAMES OF PRINCIPALS, PARTNERS, AND/OR TRUSTEES:
Firm Name_______ __________________________________________________________________________________ Firm Address_______________________________________________________________________________________
List the names of all principals, partners, and/or trustees. For corporations provide names of officers, directors and all stockholders owning more than 10% equity interest in corporation:
_______________________ ____________________________________________ D a t e S i g n a t u r e
____________________________________________
Print Name & Title
_______________________ ____________________________________________ D a t e S i g n a t u r e
____________________________________________
Print Name & Title