~~It V~e' - . 0, , - Jersey City

PUBLIC DISCLOSURE INFORMTION
Chapter 33 of the Public Laws of 1977 provides that no Corporation or Partnership shall be
awarded any State, City, Municipal or Schools Òistrict contracts for the performance of any
work or the fuishing of any materials or supplies, unless prior to the receipt ofthe bid or
accompanying the bid of said corporation or parnership there is submitted a public disclosure
information statement. The statement shall set forth the names and addresses of all stockholders
,¡ in the corporation or parership who own ten percent (10%) or more of its stock of any class, or
of all individual parters in the partership who own a ten percent (10%) or greater interest
therein.
STOCKHOLDERS:
Name Address
Ro~f- ... H~ i L ~
:r",Ji~ i~
SIGNATU:
TITLE:
~ 0 l W\~~ \y,v.
A..1. MI\ O;)fl'r;
(toi.l
""A 6.: 71'
SUBSCRIED AND SWORN TO _
BEFORE ME THIS DAY J t\~"'p.~ 11 OF 20 I 0
(TYE OR PRIT NAME OF AFFIAT UNER SIGNATU)
'NOTARYPUBLICOF M"..~~+l ~ ""7.. ~
MY COMMISSION EXPIRS: 20~\ /(/"' r
(NOTE: THIS FORM MUST BE COMPLETED, NOTARZED AND RETUED
WITH THIS PROPOSAL).
% owned
Vk\~
(,iNt'
. Notary Public
. . co, MMONWEAi, TN Of MASI"CHusm, s
MV,COlmll'on bpie. Deembei 16. 2011
W~ TIMOTHY JOHN FRENCH