Trawl OI Form Additional Format 2

Section B – Identification of Shareholders and Partners (Additional Format)
__________________ Level
NOTE: Owners of a business entity must be listed down to the level of individual persons that make up that business. If more than
one business is listed, be clear which individuals belong to which business.
NAME
(Last, First, Middle Initial)

TIN or DOB

BUSINESS MAILING ADDRESS
(Street or PO Box, City, State, Zip Code)

% INTEREST
HELD

Business Name

TOTAL OWNERSHIP OF BUSINESS =

%