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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 />c~JyA/~oGq coUNTY ~ ss <br />The undersigned, ~0/~ ~S ZZ~ C~EAh? T,U~. b~~ QUf}~(T~' ~utc~SNA~(~S <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 undersigned further states that the undersigned has delinquent personal property <br />taxes on the general tax list of personal property of Cuyahoga County, Ohio, and the amount of <br />such due and unpaid delinquent taxes and unpaid penalties and interest thereon are as follows: <br />Affiant further saith not. <br />1 <br />/LCc R/L <br />SWORN TO BEFORE ME~iND SUBSCRIBED IN MI' PRESENCE this ~ day of <br />//`~G'~'i~1~~', 20 f/ <br />`~p,4tx <br />_=q~ ~\~ ~~i~~c~ _ BONNIE L .~° ,~- _._ <br />r <br />~, .- .. . KNALL <br />t; ~* _ Notary Public, State of Ohio ~ _~ ~' ~ t ~` <br />;a~ ~' ~~ E~iras Sept. 27,1015 Notary Public <br />~'~~ F o'Y':~` ~i~~ q~YehoAa County <br />-„4,,,,~ <br />DTA-1 <br />