NYS COVID-19 PANDEMIC SMALL BUSINESS RECOVERY GRANT PROGRAM 1

Schedule of Ownership Form

OWNER #1 OWNER #1 PHOTO ID

To complete the funding for the grant, applicant must submit schedule This step is required. Please upload your photo ID by clicking the box
of ownership information for all owners with 20% or more ownership below. NOTE: You must download this form and save it on your
of business: listing of names, addresses, Social Security Numbers, device before uploading your photo ID. Your form responses and
phone numbers, e-mails, percentage ownership, and photo ID. photo ID will not save if completed in your web browser.

Name

Residential Address

City

State

Postal Code

Phone Number

E-mail

Percentage
Ownership
NYS COVID-19 PANDEMIC SMALL BUSINESS RECOVERY GRANT PROGRAM 2

Schedule of Ownership Form

OWNER #2 OWNER #2 PHOTO ID

This step is required. Please upload your photo ID by clicking the box
below. NOTE: You must download this form and save it on your
device before uploading your photo ID. Your form responses and
photo ID will not save if completed in your web browser.

Name

Residential Address

City

State

Postal Code

Phone Number

E-mail

Percentage
Ownership
NYS COVID-19 PANDEMIC SMALL BUSINESS RECOVERY GRANT PROGRAM 3

Schedule of Ownership Form

OWNER #3 OWNER #3 PHOTO ID

This step is required. Please upload your photo ID by clicking the box
below. NOTE: You must download this form and save it on your
device before uploading your photo ID. Your form responses and
photo ID will not save if completed in your web browser.

Name

Residential Address

City

State

Postal Code

Phone Number

E-mail

Percentage
Ownership
NYS COVID-19 PANDEMIC SMALL BUSINESS RECOVERY GRANT PROGRAM 4

Schedule of Ownership Form

OWNER #4 OWNER #4 PHOTO ID

This step is required. Please upload your photo ID by clicking the box
below. NOTE: You must download this form and save it on your
device before uploading your photo ID. Your form responses and
photo ID will not save if completed in your web browser.

Name

Residential Address

City

State

Postal Code

Phone Number

E-mail

Percentage
Ownership
NYS COVID-19 PANDEMIC SMALL BUSINESS RECOVERY GRANT PROGRAM 5

Schedule of Ownership Form

OWNER #5 OWNER #5 PHOTO ID

This step is required. Please upload your photo ID by clicking the box
below. NOTE: You must download this form and save it on your
device before uploading your photo ID. Your form responses and
photo ID will not save if completed in your web browser.

Name

Residential Address

City

State

Postal Code

Phone Number

E-mail

Percentage
Ownership