I HEREBY AFFIRM THAT I am a duly authorized representative
of the Business and that I possess the legal authority to make this Affidavit
on behalf of myself and the business for which I am acting.
The business named above is registered in accordance with
the Corporations and Associations Article, Annotated Code of Maryland, and that
it is in good standing and has filed all of its annual reports, together with
filing fees, with the Maryland State Department of Assessments and Taxation,
Except as validly contested, the business has paid, or has
arranged for payment of, all taxes due all government entities including the
State of Maryland and has filed all required returns and reports with the
Comptroller of the Treasury, the State Department of Assessments and Taxation,
the Department of Labor, Licensing and Regulation (DLLR), and all other taxing
authorities, as applicable, and will have paid all withholding taxes due to the
State of Maryland and all other government entities prior to final settlement.
All information in this application and in the attached
exhibits, attachments, and addendums are true and complete to the best of
my/our knowledge, information, and belief. The undersigned agrees that the tax
information provided to the County and FSC First are identical to what was
submitted to the IRS. Further, I/we agree not to engage in employment practices
which deny equal employment rights to persons by reason of (i) political or
religious opinion or affiliation, marital status, race, color, creed or national
origin; (ii) sex or age, except when sex or age constitutes a bona fide
occupational qualification; or (iii) physical or mental disability of a
qualified individual with a disability.
I/we agree to comply with the State’s policy of maintaining
a drug and alcohol free workplace. I/We hereby authorize all involved in the
financing of this project to exchange freely without further authorization and
consent, any and all financial information and reports provided in connection
with this application and the processing of the grant request.
The undersigned agrees that banks,
credit agencies, State agencies, IRS and other sources are hereby authorized
now, or anytime in the future, to give FSC First or Prince George’s County, or
their assigns and successors, any and all information in connection with
matters addressed in this application, including information concerning the
payment of taxes and credit information by the applicant.
Each of the undersigned agrees to
notify us immediately, and in writing of any change in name, address, or
employment of any material adverse change (1) in any of the information
contained in these statements or (2) in the financial condition of any of the
undersigned or (3) in the ability of any other undersigned to perform its (or
their) obligations to us. In the absence of such notice or a new and full
written statement, this should be considered as a continuing statement and
substantially correct. If the undersigned fail(s) to notify us as required
above, or if any of the information herein or in the statement should prove to
be inaccurate or incomplete in any material respect, we may declare the
indebtedness of the undersigned or the indebtedness guaranteed by the
undersigned, as the case may be, immediately due and payable.
Photo, Video & Print Release
Form; I, the undersigned, hereby give my permission to the Prince George’s
Financial Services Corporation (FSC First) or Prince George’s County, its
agents and employees, to print, publish, videotape, reproduce or otherwise use
my name, photograph, or photographs, and any descriptive text regarding my
participation in this program in a publication or publications to be
disseminated publicly by FSC First to publicize and promote FSC First
activities in Prince George’s County and the State of Maryland. In order to
participate in this promotional effort, I hereby release and agree to hold
harmless and indemnify FSC First from any and all rights, claims, or interest
which I may have or which may arise as a result of FSC First’s publication of
my name, photographic likeness (print, video or electronic), or other personal
information for the purposes above-described, and I agree to hold harmless and
indemnify FSC First and Prince George’s County from any and all claims
concerning my participation in the promotional effort by third parties relating
thereto.
I further affirm that there no
outstanding, pending or anticipated claims or litigation against my company.
I further affirm that I am not
personally in bankruptcy or the business is currently in bankruptcy.
I attest that the financial information provided in this
application matches the tax return filed with the Internal Revenue Services
(IRS).
I attest that I have filled the submitted tax returns with
the Internal Revenue Services (IRS).
I further affirm to the preceding statements.