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4 <br /> • - 04(Vi, • . <br /> . • . <br /> IV. List each ambulance and rescue vehicle owned and operated by ,the <br /> applicant (see attached) . <br /> - V. Submit a financial statement indicating the net worth of- the <br /> owner of applicant over and above all debts, judgments , claims <br /> and demands 'whatso ever, <br /> VI. List the title of all actions and unsatisfied judgments of ecord <br /> including the amount of judgments againit such owner. <br /> VII . Submit the court record, if any, -of applicant, If applicant is <br /> a corporation, partnership, association or other organization, <br /> a <br /> the court record of any of the officers, directors and supervising <br /> • <br /> employees 'thereof, including the general manager or director. <br /> -It VIII. List liens , mortgages , or other encumbrances on- such ambulances <br /> • --the amount and character .thereof. <br /> IX . Describe the Insurance soy.erme...rofthe. applicant, giving the <br /> name and- address of insurox..andthe depth of such.coverage. <br /> X. Type of Ambulance Service Proposed : <br /> SMergency Transportation <br /> L:=7 Convalescent and Nonemergency Transportation *. <br /> %_2f Rescue • <br /> Z:=7 Other(Specify) <br /> • • • <br /> • <br />