Sublessor {L-SL}

Page 1 of 1 Form L-SL (/201) SUBL ESSOR L-SL (/201) 1. Trade Name of Location 2. Indicate if you are : Sublessor Concessionaire Management Company of Permittee 3. Business Entity Name for Subless or, Concessionaire or Management Company 4. Fede ral Employer Identification Number (FEIN) for Sublessor, Concessionaire or Management Company COMPLETE THE FOLLOWING: SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) - - / / Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) - - / / Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) - - / / Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) - - / / Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) - - / / Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) - - / / Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner IF YOU NEED MORE SPA CE USE ADDITIONAL CO PIES OF THIS PAGE American LegalNet, Inc. www.FormsWorkFlow.com