7. The true name and mailing address of the individual causing this document to be delivered for filing are
____________________ ______________ ______________ _____
(Last)
(First)
(Middle)
(Suffix)
______________________________________________________
(Street number and name or Post Office Box information)
______________________________________________________
_
_
__
__________________________
____________________
(City)
(State)
(Zip/Postal Code)
_______________________ ______________.
(Province – if applicable)
(Country – if not US)
(If applicable, adopt the following statement by marking the box and include an attachment.)
This document contains the true name and mailing address of one or more additional individuals
causing the document to be delivered for filing.
Disclaimer:
This form/cover sheet, and any related instructions, are not intended to provide legal, business or tax advice,
and are furnished without representation or warranty. While this form/cover sheet is believed to satisfy
minimum legal requirements as of its revision date, compliance with applicable law, as the same may be
amended from time to time, remains the responsibility of the user of this form/cover sheet. Questions should
be addressed to the user’s legal, business or tax advisor(s).
CHANGE_TDNM_ACT
Page 2 of 2
Rev. 1/01/2008