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` r <br /> License Number <br /> APPLI ,ATION FOR LICENSE: INSULATION CONTRACTORS <br /> . (a) Name and address of applicant (if a corporation or <br /> part iership, give home office address) : <br /> (b) If a partnership, list names and home addressess of <br /> all artners : <br /> (c) If a corporation , list names and home addressess of <br /> all fficers and directors : <br /> 2. Location (local address) of your business : <br /> 3. If you or any employee, partner, officer or director of your <br /> company hab ever been convicted of any crime involving <br /> fraud, dec�it or dishonesty (whether in this state or in any <br /> other jurisdiction) , list the crime and date of conviction: <br /> 4 . List all licenses held by you or any employee, partner, officer <br /> or direct4 of your business which authorizes construction or <br /> repair wor on buildi-ngs or structures (such as general con- <br /> tractor's license , plumbing and heating contractor' s license, <br /> or electrical, contractor's license) <br /> 5. (a) Has any license of the type described in question No. 4 <br /> ever b en revoked , suspended or refused to you, or any <br /> employe, partner , officer or director of your business? <br /> VMM rw_ <br />