Private Activity Bond Application For Statewide Balance - 2011 Page 4
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105
BUSINESS CERTIFICATION
We, as the Business requesting assistance through a Private Activity Bond, certify that the
information, exhibits and schedules contained herein are true and accurate statements, and
represent fairly the financial posture of the enclosed entity(ies) as of the date stated herein. We
give unconditional consent to allow the Department of Local Affairs or the Office of Economic
Development and International Trade and its agents to verify financial information or discuss
information regarding the Business and its primary shareholders/guarantors herein with
participants in the project or with other potential sources from which the Bus iness may obtain
financing.
Typed or Printed Name
Signature
Business Title/Capacity
Business Name
Date
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