TP-115 (9/95) Page 3
17
During the last five years, has the applicant or anyone listed in item 12:
— owned or controlled, directly or indirectly, more than 10% of the voting stock (25% or more if four or fewer
shareholders own or control the voting stock) of a business other than the one for which you are applying, or
— been an officer, director or partner of a business other than the one for which you are applying .........................
Yes
No
If Yes , complete below. Attach additional sheets if necessary.
Name of other business
Federal identification number
Address
(number, street, city, state, ZIP code)
Name of person or applicant
Name of other business
Federal identification number
Address
(number, street, city, state, ZIP code)
Name of person or applicant
Name of other business
Federal identification number
Address
(number, street, city, state, ZIP code)
Name of person or applicant
Name of other business
Federal identification number
Address
(number, street, city, state, ZIP code)
Name of person or applicant
18
Does the applicant, anyone listed in item 12, or any business listed in item 17 (at the time anyone listed in
item 12 was connected with the business) have any outstanding tax liabilities under the Tax Law or the New
York City nonresident earnings tax? ...........................................................................................................................
Yes
No
If Yes , complete below. Attach additional sheets if necessary.
Name of application, person or business
Type of tax
Amount due
Assessment number
Assessment Date
19
Within the preceding five years, was the applicant or anyone listed in item 12, or any business listed in item 17
(at the time anyone listed in item 12 was connected with the business) convicted of any crimes (see
instructions)? ...............................................................................................................................................................
Yes
No
If Yes , complete below. Attach additional sheets if necessary.
Name of applicant, person or business
City and state of arrest
Date of conviction
Court of conviction
Statute section convicted of violating Disposition
(fine, imprisonment, etc.)
Description of charges