Disclosure Of Ownership (Corp) Form. This is a Louisiana form and can be use in Commercial Division Secretary Of State.
Tags: Disclosure Of Ownership (Corp), 320, Louisiana Secretary Of State, Commercial Division
DISCLOSURE OF OWNERSHIP Tom Schedler Secretary of State (R.S. 12:25 E, 12:205 E and 12:304 A (II)) Enclose $20 filing fee Make remittance payable to Secretary of State Do Not Send Cash Return to: Commercial Division P. O. Box 94125 Baton Rouge, LA 70804-9125 Phone (225) 925-4704 Web Site: www.sos.la.gov State of Parish/County of BEFORE ME, the undersigned Notary in and for the parish/county herein above shown, personally came and appeared the undersigned who, after being duly sworn, did depose and say that: Corporation Name is contracting with the state and listed below are the names and addresses of all persons or corporate entities who hold ownership interest of five percent or more in the corporation or who hold by proxy the voting power of five percent or more in the corporation and, if anyone is holding stock in his own name that actually belongs to another, the name of the person for whom held, including stock held pursuant to a counter letter. 1. Persons or corporate entities owning 5% or more: Name Name Address Name 2. Address Address Persons or corporate entities who hold by proxy the voting power of 5% or more: Name Name Address Name 3. Address Address Stock held for others and for whom held: Name Address For Whom Held Address Name Address For Whom Held Address Name Address For Whom Held Address NOTARY NAME MUST BE TYPED OR PRINTED WITH NOTARY # Sworn to and subscribed before me, the undersigned Notary Public, on this date: Corporation Representative SS320 Rev. 09/11 Notary Signature (See instructions on back) American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS 1. This form is be used when an existing corporation intends to contract with the state. This requirement does not apply to non profit corporations organized on a “non stock” basis, any agreement entered between the state and a corporation for electric or gas service, publicly traded corporations, or state chartered banks. 2. You will receive a copy marked “received and filed” by the Secretary of State. You may furnish a photostatic copy of the “filed” form to the appropriate state agency. American LegalNet, Inc. www.FormsWorkFlow.com