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<br />22. The above statements are true and correct to the best of my knowledge. <br /> <br />Signature <br /> <br />Telephone <br /> <br />Date <br /> <br />Date Received <br /> <br />Date Paid <br /> <br />Date for end of lO-day Review_ <br /> <br />Receipt Number <br /> <br />Q:\Planning Commission \Application form.doc <br /> <br />Page 5 of5 <br />