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The undersigned certifies that all information provided in this application is true and correct <br /> to the best of the undersigned's knowledge. The undersigned authorizes the city of Elk <br /> River to check credit references,verify financial and other information,and share this <br /> information with other political subdivisions as needed. The undersigned also agrees to <br /> provide any additional information as may be requested by the city after the filing of this <br /> application. <br /> The undersigned has received the city's policy regarding the payment of costs of review, <br /> understands that reimbursement to the city of costs incurred in reviewing the application will <br /> be required, agrees to reimburse the city as required in the policy and make payment when <br /> billed by the city,and agrees that the application may be denied for failure to reimburse the <br /> city for costs as provided in the policy. <br /> Applicant Name Date <br /> Page 12 of 15 POWERED 0r <br /> INAWREI <br />