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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 EDA & City Council Approved April 17, 2017 Fa V tt 0 F-6—" f <br />