Looking for a New York City Department Of Finance Forms And Templates? Download it for free!

Form Tp-115 - Application For Registration As An Aviation Fuel Business Or As A Residual Petroleum Product Business Page 3

TP-115 (9/95) Page 3

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

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

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

If Yes , complete below. Attach additional sheets if necessary.

Name of application, person or business

Type of tax

Amount due

Assessment number

Assessment Date

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

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