Attachment B-11 Ownership ... - Harris County, Texas



Harris County CDBG-DR Affordable Rental Housing RFPAttachment B-11LIST OF ORGANIZATIONS WITH AN OWNERSHIP OR SPECIAL INTEREST IN THE APPLICANTProvide the requested information for all partnerships, corporations, limited liability companies, trusts, or any other public or private entity and their Affiliates that will have an ownership interest in or that will exercise control over the Applicant. Organizations that own or control other organizations should also be identified until the only remaining sub-entity would be natural persons. However, if the Applicant is directly owned or controlled by a person or persons, then the individual’s information should be provided below and in the “List of Principals of Organizations with an Ownership or Special Interest in the Applicant” form. Organizations that are Developers and/or guarantors must also be listed on this form as must any organization (and natural person whose ownership interest in an applicable entity is direct instead of via membership in an organization) that will receive more than 10% of the developer anization Legal Name: FORMTEXT ?????Contact Name: FORMTEXT ?????Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ??ZIP: FORMTEXT ?????Phone:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Fax:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Email: FORMTEXT ?????Name(s) and Ownership % of Entities the Organization Owns or Controls: FORMTEXT ????? FORMTEXT ?????%Is Organization legally formed? FORMCHECKBOX Yes FORMCHECKBOX NoDate of formation: FORMTEXT ?????Legal Form of Organization is or will be (mark all that apply): FORMCHECKBOX For-profit Corporation FORMCHECKBOX Nonprofit Corporation FORMCHECKBOX General Partnership FORMCHECKBOX Limited Partnership FORMCHECKBOX Limited Liability Company FORMCHECKBOX Unit of Local Government FORMCHECKBOX Housing Authority FORMCHECKBOX Individual/DBAOther Designations (mark all that apply): FORMCHECKBOX Historically Underutilized Business FORMCHECKBOX Federal Tax Exemption FORMCHECKBOX Community Housing Development anization Legal Name: FORMTEXT ?????Contact Name: FORMTEXT ?????Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ??ZIP: FORMTEXT ?????Phone:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Fax:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Email: FORMTEXT ?????Name(s) and Ownership % of Entities the Organization Owns or Controls: FORMTEXT ????? FORMTEXT ?????%Is Organization legally formed? FORMCHECKBOX Yes FORMCHECKBOX NoDate of formation: FORMTEXT ?????Legal Form of Organization is or will be (mark all that apply): FORMCHECKBOX For-profit Corporation FORMCHECKBOX Nonprofit Corporation FORMCHECKBOX General Partnership FORMCHECKBOX Limited Partnership FORMCHECKBOX Limited Liability Company FORMCHECKBOX Unit of Local Government FORMCHECKBOX Housing Authority FORMCHECKBOX Individual/DBAOther Designations (mark all that apply): FORMCHECKBOX Historically Underutilized Business FORMCHECKBOX Federal Tax Exemption FORMCHECKBOX Community Housing Development anization Legal Name: FORMTEXT ?????Contact Name: FORMTEXT ?????Address: FORMTEXT ?????City: FORMTEXT ?????State: FORMTEXT ??ZIP: FORMTEXT ?????Phone:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Fax:( FORMTEXT ???) FORMTEXT ???- FORMTEXT ????Email: FORMTEXT ?????Name(s) and Ownership % of Entities the Organization Owns or Controls: FORMTEXT ????? FORMTEXT ?????%Is Organization legally formed? FORMCHECKBOX Yes FORMCHECKBOX NoDate of formation: FORMTEXT ?????Legal Form of Organization is or will be (mark all that apply): FORMCHECKBOX For-profit Corporation FORMCHECKBOX Nonprofit Corporation FORMCHECKBOX General Partnership FORMCHECKBOX Limited Partnership FORMCHECKBOX Limited Liability Company FORMCHECKBOX Unit of Local Government FORMCHECKBOX Housing Authority FORMCHECKBOX Individual/DBAOther Designations (mark all that apply): FORMCHECKBOX Historically Underutilized Business FORMCHECKBOX Federal Tax Exemption FORMCHECKBOX Community Housing Development Org.Additional pages of this form can be found at the “2009 Additional Forms” link on the Department’s website.Harris County CDBG-DR Affordable Rental Housing RFPAttachment B-11LIST OF PRINCIPALS OF ORGANIZATIONS WITH AN OWNERSHIP OR SPECIAL INTEREST IN THE APPLICANTThis form must include all organizations and natural persons with an ownership interest in the Development Owner, Developer, or Guarantor or that will receive more then 10% of the developer fee. This form must also include the executive directors and board members of nonprofits, corporations and government instrumentalities (even if the executives and board members own “0%” of the organization.) Organization Name:Principal Name:Role/Title% Interest in the Org.Principal has Previous Participation with Funding from GLO:Organization 1.1(Blank if space to left is not blank)Development Owner100% FORMCHECKBOX Yes FORMCHECKBOX NoPrincipal 1General Partner100% FORMCHECKBOX Yes FORMCHECKBOX NoOrganization 1.2 (the GP, e.g. a non profit)(Blank if space to left is not blank)General Partner100% FORMCHECKBOX Yes FORMCHECKBOX NoPrincipal 1Executive Director0% FORMCHECKBOX Yes FORMCHECKBOX NoPrincipal 2Board Member0% FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX No FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMCHECKBOX Yes FORMCHECKBOX NoIf another page is required, complete an additional page to include after this one. ................
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