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<br />22. The above statements are true and correct to the best of my knowledge. <br /> <br />~~c~ <br /> <br />~/-:z. eZ~_707' ~rz- "'l't-5' -<::)007 <br />Telephone <br />~/(;/'1q <br />, , <br />Date <br /> <br />Date Received <br /> <br />Date for end of lO-day Review_ <br /> <br />Date Paid <br /> <br />Receipt Number <br /> <br />Q:\Planning Commission\Application form,doc <br /> <br />Page 5 of5 <br />