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<br />22. The above statements are true and correct to the best of my knowledge. <br /> <Jf~~ AI~, <br /> &GI j - Lj-gg-03t1S <br /> - <br /> Tel9hone <br /> -lIP -99 <br /> Date <br /> Date Received Date for end of lO-day Review_ <br /> Date Paid Receipt Number <br />Q:\Planning Commission \Application form.doc <br /> Page 5 of5 <br />