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<br />22. The above statements are true and correct to the best of my knowledge. <br /> <br />~~~ <br />signatnrl'; -u <br />G$ \.. ~j" ~ ~ <br />Telephone ~ <br />~-\<\-~ <br />Date <br /> <br />Date Receive4M44. <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 of 5 <br />