Laserfiche WebLink
❑ Yes <br />Q No <br />If yes, explain: <br />13. Does any member of the governing body of the City of South Bend or any public <br />official or employee of the City of South Bend have any direct or indirect personal <br />interest in the 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 <br />hereto and hereby made a part hereof as follows: <br />Certification <br />I (We), S tin T PA a y- Certify that this Statement of <br />Qualifications and Financial Responsibility and the attached evidence of the Applicant's <br />qualifications and financial responsibility, including financial statements, are true and <br />correct to the best of my (our) knowledge and belief. <br />A A %7!7 C. <br />Name <br />Signature <br />Title <br />l ZZ S Z i/ <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 <br />the partners; if a corporation or other entity, by one of its chief officers having knowledge of the facts required by <br />this statement.) <br />M <br />