Private Activity Bond Application For Statewide Balance - 2011 Page 5

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CREDIT INVESTIGATION FORM
The Department of Local Affairs or the Office of Economic Development and International
Trade has my permission to obtain information on my personal and/or business credit history.
Name (Printed or Typed)
Spouse’s Name (Printed or Typed)
Social Security Number
Spouse’s Social Security Number
Current Address
Previous Address
Date of Birth
Spouse’s Date of Birth
Signature
Date
Spouse’s Signature
Date
Name of Business

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