SUBSIDIARY AFFIDAVIT STATE OF _________________________: COUNTY OF _________________________: ______________________________________, being first duly cautioned and sworn, deposes and states as (Your Name) follows: ______________________________________, has previously filed a Subsidiary Disclosure Statement on (Company Name) ______________________________, 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 Subsidiary 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. American LegalNet, Inc. www.FormsWorkflow.com