10.	Type of Ownership:	Nonprofit Cooperative
11.	Corporation Information:	NONE

12a.  Person Information: Only owners, officers and corporate contacts are displayed below. All roles are displayed on the Persons page. Name:  ILYAS HUSSAIN SSN:  340-46-9911 SSN Verification Code:  Never verified with SSA Date of Birth:  05/30/1952 E-mail Address:  NONE Role:  Owner Title:  SECRETARY/ VICE PRESIDENT Date of Association:  05/01/1996 Address: 972 Old Norcross Tucker Rd Tucker, Georgia 30084-1500 United States of America

Date screened:  NONE Screened by:  NONE Validation Result:  Validated Date Validated:  07/25/2008 Validated By:  database_maintenance

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12b.  Person Information: Only owners, officers and corporate contacts are displayed below. All roles are displayed on the Persons page. Name:  MOHAMMAD IOBAL SSN:  590-15-1726 SSN Verification Code:  Never verified with SSA Date of Birth:  08/10/1965 E-mail Address:  NONE Role:  Owner Title:  PRESIDENT Date of Association:  05/01/1996 Address: 2515 NE EXPRESSWAY APT L-4 ATLANTA, Georgia 30345 United States of America

Date screened:  NONE Screened by:  NONE Validation Result:  Not Validated Date Validated:  NONE Validated By:  NONE

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1. 13a.   Has any officer, owner, partner, member and/or manager ever been denied, withdrawn or suspended, or been fined for license violations (i.e. Supplemental Nutrition Assistance Program (SNAP), WIC, business, alcohol, tobacco, lottery, or health license)? No
2. 13b.   If Yes, provide an explanation: NONE
3. 13c.   Is any officer, owner, partner, member and/or manager currently or ever been suspended or debarred from conducting business with or participating in any program administered by the Federal Government? NONE
4. 13d.   If Yes, provide an explanation: NONE
5. 13e.   Is any officer, owner, partner, and/or member currently receiving SNAP benefits? NONE
6. 13h.   Has any officer, owner, partner and/or member ever been disqualified from receiving SNAP benefits as a recipient for an intentional program violation (IPV) or fraud? NONE
7. 13i.   If Yes, provide an explanation: NONE
8. 13j.   Does any officer, owner, partner, and/or member currently own any other SNAP authorized stores? NONE
9. 13k.   If Yes, how many currently authorized stores do you own? NONE

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1. 14.   Was any officer, owner, partner, member, and/or manager convicted of any crime after June 1, 1999? No
2. 14a.   If Yes, provide an explanation: NONE

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1. Violations or Criminal Convictions on File? NONE

15.	Do you sell products wholesale to other businesses such as hospitals or restaurants?  No
15a.	Does your retail food sales meet or exceed $250,000 or 50% of your total sales?  NONE
16.	Does the sale of hot and/or cold freshly prepared foods that are ready-to-eat exceed 50% of your total sales?  NONE
17a.	Actual Retail Sales:  NONE  in Tax Year:  NONE
17b.	Estimated Retail Sales:  $550,000.00  per:  Year Calculated Estimated Annual Sales:  $550,000.00
17c.	EIN:  97-3670062
18.	Do you stock at least three different items in each of these food categories?  Bread/Grains Dairy Fruits/Vegetables Meat/Poultry/Fish
18a.	Percent of Retail Sales from "Staple Foods":  NONE
18b.	Do you stock fresh, frozen or refrigerated foods in at least two of these food categories?  Yes
19.	Do you sell "other" foods, such as snack foods, soft drinks, or condiments?  No
19a.	Percent of Retail Sales from "Additional Food Types":  NONE
20.	Do you sell non-food items or food that is hot at the time the customer pays for it?  NONE
20a.	Tobacco Products Alcohol Lottery Gasoline Hot Food Other
20b.	Percent of Retail Sales from "Hot Foods and Non-Foods":  NONE
	Store Criteria:  A
	Store Type:  Non-profit Food Buying Co-op  Update
21.	Number of Registers:  2
22.	Open Year Round?  Yes
23.	Store Open 7 days, 24 hours?  No
23a.	Operating Hours:  Open Time   |   Close Time
24.	If you have additional information or comments you would like to provide to FNS (such as any special circumstances that FNS should know), please provide the information here:  NONE

1.	Application Signed By Information First Name:  MOHAMMAD Middle Name:  ZAKIR Last Name:  IOBAL Title:  PRESIDENT Date Application Signed:  06/04/1996
2.	Receipt of Mandatory Supporting Documents Business License:  NONE Received Date:  NONE SSN Card for ILYAS HUSSAIN:  NONE Received Date:  NONE Photo ID for ILYAS HUSSAIN:  NONE Received Date:  NONE SSN Card for MOHAMMAD IOBAL:  NONE Received Date:  NONE Photo ID for MOHAMMAD IOBAL:  NONE Received Date:  NONE
3.	Receipt of Other Supporting Documents, if required Bond:  NONE Received Date:  NONE Proof of Bona Fide Transfer of Ownership:  NONE Received Date:  NONE Proof of Inventory:  NONE Received Date:  NONE
4.	Exempt Store From Call Order Queue