Form 009-0830 "Disclosure of Company Ownership, Control, and Management" - Iowa

What Is Form 009-0830?

This is a legal form that was released by the Iowa Department of Agriculture and Land Stewardship - a government authority operating within Iowa. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2005;
  • The latest edition provided by the Iowa Department of Agriculture and Land Stewardship;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 009-0830 by clicking the link below or browse more documents and templates provided by the Iowa Department of Agriculture and Land Stewardship.

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Download Form 009-0830 "Disclosure of Company Ownership, Control, and Management" - Iowa

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IOWA DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP
GRAIN WAREHOUSE BUREAU
DISCLOSURE OF COMPANY OWNERSHIP, CONTROL AND MANAGEMENT
LICENSEE NAME:
License Nos.
LICENSEE ADDRESS:
GD:
W:
Any person who owns or controls this company shall be disclosed below:
Include branch managers and grain division heads.
Name:
Address:
Title or brief description of position:
Other employment in last three years:
Name:
Address:
Title or brief description of position:
Other employment in last three years:
Name:
Address:
Title or brief description of position:
Other employment in last three years:
I certify that the business identified on this form is not owned or controled by any person who:
(1) has had a license under chapter 203 or 203C of the Code of Iowa revoked for cause within the past
three years; or (2) has caused liability to the Iowa Grain Depositors and Sellers Indemnity Fund.
Authorized Signature of owner/officer/manager
Title
Date
(see reverse)
009-0830 rev. 5/2005
IOWA DEPARTMENT OF AGRICULTURE AND LAND STEWARDSHIP
GRAIN WAREHOUSE BUREAU
DISCLOSURE OF COMPANY OWNERSHIP, CONTROL AND MANAGEMENT
LICENSEE NAME:
License Nos.
LICENSEE ADDRESS:
GD:
W:
Any person who owns or controls this company shall be disclosed below:
Include branch managers and grain division heads.
Name:
Address:
Title or brief description of position:
Other employment in last three years:
Name:
Address:
Title or brief description of position:
Other employment in last three years:
Name:
Address:
Title or brief description of position:
Other employment in last three years:
I certify that the business identified on this form is not owned or controled by any person who:
(1) has had a license under chapter 203 or 203C of the Code of Iowa revoked for cause within the past
three years; or (2) has caused liability to the Iowa Grain Depositors and Sellers Indemnity Fund.
Authorized Signature of owner/officer/manager
Title
Date
(see reverse)
009-0830 rev. 5/2005
Name:
Address:
Title or brief description of position:
Other employment in last three years:
Name:
Address:
Title or brief description of position:
Other employment in last three years:
Name:
Address:
Title or brief description of position:
Other employment in last three years:
Name:
Address:
Title or brief description of position:
Other employment in last three years:
(see reverse)
009-0830 rev. 5/2005
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