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R2012-181 AUTHORIZING EXECUTION OF AN INTERGOVERNMENTAL AGREEMENT
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R2012-181 AUTHORIZING EXECUTION OF AN INTERGOVERNMENTAL AGREEMENT
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Last modified
8/20/2015 9:03:19 AM
Creation date
8/20/2015 9:03:10 AM
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Resolution/Ordinance
Res Ord Num
R2012-181
Res Ord Title
AUTHORIZING EXECUTION OF AN INTERGOVERNMENTAL AGREEMENT - MAHOMET AQUIFER
Department
Legal
Approved Date
10/15/2012
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EXHIBIT"C" <br /> DISCLOSURE AFFIDAVIT <br /> Albert Ettinger <br /> (NOTE: This Affidavit must be completely filled out and signed by any party doing business with the City. <br /> STATE OF ILLINOIS ) <br /> )ss. <br /> COUNTY OF COOK ) <br /> SECTION 1. BUSINESS STATUS STATEMENT <br /> I, the undersigned, being duly sworn, do state as follows: <br /> A. Albert Ettinger, attorney at law, is a: <br /> (Place mark in front of appropriate type of business) <br /> Corporation (if a Corporation, complete B) <br /> Partnership (if a Partnership, complete C) <br /> Limited Liability Corporation (if an LLC, complete C) <br /> X Individual Proprietorship (if an Individual, complete D) <br /> Service Provider's Federal Tax Identification Number, or in the case of an individual or sole <br /> proprietorship, Social Security Number: 300-44-9874. <br /> B. CORPORATION <br /> The State of Incorporation is <br /> Registered Agent of Corporation in Illinois: Business Information (if Different from Above): <br /> Name Company Address, Principal Office <br /> Address City, State, Zip <br /> ity, State, Zip Telephone Facsimile <br /> elephone Website <br /> 1 <br />
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