Business Address: (Street, City, State, Zip Code) 81 School Street, Winchendon, MA 01470 Position: income derived, if in excess of $1000: 1~ Officer Director Trustee "Income" includes any fee, salary, allowance, forgiveness, interest, dividend, royalty, rent, capital gain, and any other form of compensation, or any combination of the foregoing. ~ n/a D $1,001 to 5,000 D $ 5,001 to 10,000 $10,001 to 20,000 D $20,001 to 40,000 D $40,001 to 60,000 $60,001