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Submission of this application expressly authorizes the City of North Olmsted and/or Cuyahoga County to contact the Ohio <br />Environmental Protection Agency to confirm statements contained within this application, including item p5, and to review <br />applicable confidential records. As part of this application, the company may also be required to directly request from the <br />Ohio Department of Taxation or complete a waiver form allowing the Oho Department of Taxation to release specific tax <br />records to the local jurisdictions considering the incentive request. <br />Applicant agrees to supply additional information upon request. <br />The applicant affirmatively covenants that the Information contained in and submitted with this application is complete and <br />correct and is aware of the ORC Sections 9.66(c)(1( and 2921.13(d( penalties for falsification which could result in the <br />forfeiture of all current and future economic development assistance benefit as well as a find of not more than $1000 and <br />/or a term of imprisonment of not more than six months. <br />3/19V2024 <br />Signaturilf Date <br />Star -West Great Northern Mall, LLC <br />Name of Company <br />Bradley E. Scher, Chief Restructuring Officer <br />Print Name and Title <br />Submit completed Financial Assistance Applications along with a $750 application fee to the Planning and Development <br />Department. For applicants seeking a CRA Property Tax Abatement, please make checks payable to the "Ohio Department <br />of Development" <br />W W W.NORTH-OLMSTED.COM <br />