Documentation: Attached OFFICER(S) OR ANY PERSON IN A MANAGEMENT CAPACITY: Ever been convicted of, or pled guilty to a felony, or are charges * If any question in this pending? No section is answered you must attach Yes “yes”, to this application a Documentation: Attached written explanation of your answer. You must also include official court Ever been convicted of or pled to documentation which a misdemeanor other than a minor details the date and circumstances traffic violation or are misdemeanor surrounding the case including, if applicable, charges pending? No charges and disposition Yes of the court case. Documentation: Attached Ever been dismissed or allowed to resign from any position for immoral or unprofessional conduct? No Yes Documentation: Attached Ever had a professional license or permit Disciplined, denied; revoked; or relinquished in this or any other state? No Yes
OFFICER(S) OR ANY PERSON IN A MANAGEMENT CAPACITY: * If any question in this section is answered “yes”, you must attach to this application a written explanation of your answer. You must also include official court documentation which details the date and circumstances surrounding the case including, if applicable, charges and disposition of the court case. Documentation: Attached Ever been convicted of, or pled guilty to a felony, or are charges pending? No Yes Documentation: Attached Ever been convicted of or pled to a misdemeanor other than a minor traffic violation or are misdemeanor charges pending? No Yes Documentation: Attached Ever been dismissed or allowed to resign from any position for immoral or unprofessional conduct? No Yes Documentation: Attached Ever had a professional license or permit Disciplined, denied; revoked; or relinquished in this or any other state? No Yes
Change%20of%20Ownership%202018.docx