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<br /> <br />If yes, please describe: <br /> <br /> <br />I/we certify that the information is true and correct to the best of my/our knowledge. <br /> <br /> <br /> <br />Signature of Applicant Date <br /> <br /> <br /> <br />Signature of Applicant Date <br /> <br /> <br />Note: If a conflict exists, the city and program administrator will review conflict to determine if an <br />exception to the conflict can be approved. <br />7 <br /> <br />