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Statement of Qualifications and Financial Responsibility <br />Applicant: <br />Address: <br />1. Is the Applicant a subsidiary of or affiliated with any other corporation or corporations or <br />any other firm or firms? <br />❑ Yes <br />❑ No <br />If yes, list each corporation or firm by name and address, specify its relationship to the Applicant, <br />and identify the officers and directors or trustees common to the Applicant and such other <br />corporation or firm: <br />2. The financial condition of the Applicant, as of , , is as <br />reflected in the attached financial statement. <br />Name and address of auditor or public accountant who performed the audit on which said financial <br />statement is based: <br />(NOTE: Attach to this statement a certified financial statement showing the assets and the liabilities, fully itemized in <br />accordance with accepted accounting standards and based on a proper audit. !f the date of the certified financial <br />statement precedes the date of this submission by more than six months, also attach an interim balance sheet not more <br />than 60 days old.) <br />3. If funds for development of the land are to be obtained from sources other than the <br />Applicant's own funds, a statement of the Applicant's plan for financing the acquisition <br />and development of the land: <br />