Basic Information Project Title: Parcel No.: Legal name of business: Displacee No.: DBA: Business phone: Owner(s) name(s), if different from above: Fax: Alternate phone: Email: Occupancy Date: Type of operation: Business site address: Business mailing address: Landlord Retail NPO Manufacturing Other Title VI Required Information: African American Asian/Pacific Islander Hispanic American American Indian/Alaskan Native Caucasian Other MWBE: Yes No DBE: Yes No (Disadvantaged ) (Minority Women Business ) Business Present Operation Type of Displacement: Business Farm NPO Corporation Partnership LLC Sole Proprietor Describe Nature of Business: Total building(s) square footage: size: Number of employees: Replacement preference: Number & types of other businesses owned: Purchase Lease Own Land Number: Types: Any special utility needs: Requirements: Do you depend on truck deliveries? Yes No Size: Access From: Special displacement building features: Land: Own Lease Lease rate: Expiration of lease: Building: Own Lease Lease rate: Expiration of lease: Special lease terms: Renewal options in lease: Do you sublease any portion of this property: Yes No Was the business grandfathered in: Yes No Do you own or lease any other property for this business: Special zoning requirements: Shareholders or partners of business: Do you plan to keep your business in operation: Yes No Hours & days of operation: Seasonal business: Slow time of year: Busy time of year:
Basic Information Project Title: Parcel No.: Legal name of business: DBA: Displacee No.: Business phone: Owner(s) name(s), if different from above: Fax: Alternate phone: Email: Occupancy Date: Type of operation: Landlord Retail NPO Manufacturing Other Business site address: Business mailing address: Title VI Required Information: African American Asian/Pacific Islander Hispanic American American Indian/Alaskan Native Caucasian Other MWBE: Yes No DBE: Yes No (Minority Women Business ) (Disadvantaged Business ) Present Operation Type of Displacement: Business Farm NPO Corporation Partnership LLC Sole Proprietor Describe Nature of Business: Total building(s) square footage: size: Number of employees: Replacement preference: Purchase Lease Own Land Number & types of other businesses owned: Number: Types: Any special utility needs: Requirements: Do you depend on truck deliveries? Yes No Size: Access From: Special displacement building features: Land: Own Lease Lease rate: Expiration of lease: Building: Own Lease Lease rate: Expiration of lease: Special lease terms: Renewal options in lease: Do you sublease any portion of this property: Yes No Was the business grandfathered in: Yes No Do you own or lease any other property for this business: Special zoning requirements: Shareholders or partners of business: Do you plan to keep your business in operation: Yes No Hours & days of operation: Seasonal business: Busy time of year: Slow time of year: