Applicant Disclosure And Non-Applicant Business Concern Disclosure Forms Affidavit
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Applicant Disclosure And Non-Applicant Business Concern Disclosure Forms Affidavit Form. This is a Ohio form and can be use in Attorney General Office Statewide.
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Tags: Applicant Disclosure And Non-Applicant Business Concern Disclosure Forms Affidavit, Ohio Statewide, Attorney General Office
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.
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