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Applicant Disclosure And Non-Applicant Business Concern Disclosure Forms Affidavit - Ohio

Applicant Disclosure And Non-Applicant Business Concern Disclosure Forms Affidavit Form. This is a Ohio form and can be used in Citizen Protection Attorney General Office Statewide .
 Fillable pdf Last Modified 3/21/2011
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APPLICANT DISCLOSURE & NON-APPLICANT BUSINESS CONCERN DISCLOSURE FORMS AFFIDAVIT STATE OF _________________________: COUNTY OF _________________________: ______________________________________, being first duly cautioned and sworn, deposes and states as (Your Name) follows: ______________________________________, has previously filed an (please circle one) Applicant Disclosure (Company Name) Form or Non-Applicant Business Concern Disclosure Form on ______________________________, with the Ohio Attorney General's Environmental Background Investigation Unit (EBIU). I, ______________________________________, hereby swear or affirm under the penalties of perjury and (Your Name) falsification that there are no changes to the (please circle one) Applicant Disclosure Form or Non-Applicant Business Concern Disclosure Form except through previously filed Affidavits or as follows: ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Dated this _____ day of ____________________________, 20__. Signature_____________________________________ Sworn to and subscribed before me this _____ day of ____________________________, 20__. _____________________________________________ NOTARY PUBLIC My Commission Expires:_________________________ Under Ohio Revised Code 2921.11 and 2929.11, perjury is a felony of the third degree; punishable by imprisonment for one to ten years and a fine up to $5,000. Under Ohio Revised Code 2921.13 and 2929.21, falsification is a misdemeanor of the first degree; punishable by imprisonment for six months and a fine up to $1,000. Please be advised: Individuals completing this form are not required to include changes to information disclosed in previous Personal History Disclosure Forms if that information is no longer required to be disclosed in the current Personal History Disclosure Form. American LegalNet, Inc. www.FormsWorkFlow.com
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