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Business Concern Affidavit Form. This is a Ohio form and can be use in Attorney General Office Statewide.
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Tags: Business Concern Affidavit, Ohio Statewide, Attorney General Office
BUSINESS CONCERN AFFIDAVIT
STATE OF _________________________:
COUNTY OF _________________________:
______________________________________, being first duly cautioned and sworn, deposes and states as
(Your Name)
follows:
______________________________________, has previously filed a Business Concern Disclosure Statement
(Company Name)
on ______________________________, with the Ohio Attorney General’s Environmental Background
Investigation Unit (EBIU) relating to the ________________________________________ facility located at
_____________________________________________ in _____________________, Ohio.
I, ______________________________________, hereby swear or affirm under the penalties of perjury and
(Your Name)
falsification that there are no changes to my Business Concern Disclosure Statement except through previously
filed Affidavits or as follows: __________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
___________________________________________________________________________________________
Dated this _____ day of ____________________________, 200__.
Signature_____________________________________
Sworn to and subscribed before me this _____ day of ____________________________, 200__.
_____________________________________________
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.
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