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SIGNATITRES <br />The applicant and business(es), by and through their agent's signatures below (1) certify that all information provided in <br />connection with this application at any time is true and correct to the best of their knowledge; (2) acknowledge that any <br />misrepresentation or false statement made in connection with this application, whether intentional or not, will constitute <br />grounds for denial, pursuant to this application and/ar assessment of monetary administrative penalties. If signed by an agent <br />(including employee) of the applicant or business(es), the person signing certifies that he or she is autharized to make the <br />preceding certifications. <br />Chief Elected Official (Printed Name) <br />Title <br />Jesse Freelen <br />Mayor <br />Applicant Signature <br />Date <br />x <br />Month day year <br />~ <br />Business Representative (Printed Name) <br />Title <br />F, <br />David Sokolsky <br />Manager <br />U <br />~ <br />Business Representative's Signature <br />Date <br />Month day year <br />Business Representative (Printed Name) <br />Title <br />Business Representative's Signature <br />Date <br />Month day year <br />Business Representative (Printed Name) <br />Title <br />Business Representative's Signature <br />Date <br />Month day year <br />