(b)

1. (1) The application shall state:

   1. (A) The name, age, and address of the applicant, if an individual;
   2. (B) The name, age, and address of each partner, if the applicant is a partnership; and
   3. (C) The name, age, and address of each member of the board of directors or other governing body and each officer and the managing agent, if the applicant is:

(i) A partnership;

1. (ii) A corporation; or

   1. (iii) An association.
2. (2) In addition, the application shall state the name and address of each person financially interested in the permitted business for which application is made, together with the nature of such interests, but if such applicant is a corporation, the applicant shall set forth only the name or names and address or addresses of all stockholders holding more than five percent (5%) interest in the permitted business.
3. (3) In addition, the same information may be required by the Director of Arkansas Tobacco Control of any manager, director, officer, or member retained by or having interests in the business.
4. (4) The application shall further provide a telephone number which must be listed in the name of the business seeking the application.