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12. Does any member of the South Bend Redevelopment Commission or any officer or <br />employee of the City of South Bend Department of Redevelopment have any direct or <br />indirect personal interest in the Applicant or the development of the land as proposed? <br />❑ Yes <br />❑ No <br />If yes, explain: <br />13. Does any member of the governing body of the City of South Bend or any public official <br />or employee of the City of South Bend have any direct or indirect personal interest in the <br />applicant or the development of the land as proposed? <br />If yes, explain: <br />14. Statements and other evidence of the Applicant's qualifications and financial <br />responsibilities (other than the financial statement referred to above) are attached hereto <br />and hereby made a part hereof as follows: <br />Certification <br />I (We), Certify that this Statement of Qualifications <br />and Financial Responsibility and the attached evidence of the Applicant's qualifications and financial <br />responsibility, including financial statements, are true and correct to the best of my (our) knowledge and <br />belief. <br />Name <br />Signature <br />Title <br />Date <br />Name <br />Signature <br />Title <br />Date <br />(If the Applicant is an individual, this statement should be signed by such individual; if a partnership, by one of the partners; if a <br />corporation or other entity, by one of its chief ofcers having knowledge of the facts required by this statement.) <br />