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EXHIBIT A continued <br />Submission of this application expressly authorizes the Village of Mayfield to contact the Ohio <br />Environmental Protection Agency to confirm the statements contained within this application including <br />item #5 and to review applicable confidential records. As part of this application, the Property Owner <br />may also be required to directly request from the Ohio Department of Taxation, or complete a waiver <br />form allowing the Ohio Department of Taxation to release specific tax records to the local jurisdiction <br />considering the request. <br />The applicant agrees to supply additional information upon request. <br />The applicant affirmatively covenants that the information contained in and submitted with this <br />application is complete and correct, and is aware of the Ohio Revised Code Sections 9.66(C)(1) and <br />2921(D)(1). Penalties for falsification could result in forfeiture of all current and future economic <br />development assistance, as well as a fine of not more than $1,000 and / or a term of imprisonment of not <br />more than six months. <br />GLHG Msyfield Holdings LLC <br />1rAm <br />Name of Property Owner Date <br />A,z,�— Amit Petal, Mansging Member <br />Signature Printed Name and Title <br />••A copy of this proposal must be forwarded by the Village of Mayfield to the affected Board of <br />Education, along with notice of the meeting date on which the local government will review the proposal. <br />Notice must be given a minimum of fourteen (14) days prior to the scheduled meeting to permit the Board <br />of Education to appear and / or comment before the legislative authorities considering the request. <br />"Attach to Final Community Reinvestment Area Agreement as Exhibit A. <br />"Please note that copies of this proposal must be included in the Final Community Reinvestment Area <br />Agreement and be forwarded to the Ohio Department of Taxation and the Ohio Development Services <br />Agency within fifteen (15) days of final approval. <br />13 <br />