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DELINQUENT TAX AFFIDAVIT <br />(As per Ohio Revised Code Section 5719.042; <br />to be completed prior to signing contract) <br />STATE OF OHIO } <br />SS <br />~,, M. ~,., i ~ COUNTY ) <br />The undersigned, -~ ~4 So ~ ~~'4 <br />E'v `~ <br />whether one or more than one, and if a corporation or partnership its official who signs these <br />presents, being first duly cautioned and sworn according to law, deposes and states that the <br />undersigned is entering into a contract with the City of North Olmsted, Ohio, a municipal <br />corporation, pursuant to a competitive bid heretofore submitted. <br />DELETE THE PARAGRAPH THAT IS INAPPLICABLE <br />The undersigned further states that the undersigned has no delinquent personal property <br />taxes on the general list of personal property of Cuyahoga County, Ohio. <br />The and sign rther states that the undersigne a mquent personal property <br />taxes on the general tax list o p roe yahoga County, Ohio, and the amount of <br />such due and unpaid delinque unpai pe interest thereon aze as follows: <br />Affiant further with not. <br />,~'d c _ <br />SWORN TO BEFORE ME AND SUBSCRIBED IN MY PRESENCE this -- day of <br />nnui°n„qi~~ _ .. <br />°'~'. ~ `1 ~•~f RYI~P! P PaArvn~ ai n ,~F <br />_ ~T,RY NOtazy. b11C <br />~`~, IUN txriKca: ,~~0,'2014 <br />~'. ;n <br />nTA_t <br />