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<br />RELOCATION NEEDS ASSESSl\1ENT FORM <br />PAGE 6 <br /> <br />******PLEASE READ AND SIGN BELOW****** <br /> <br />WARNING! Section 18 of the U. S. Code makes it a criminal offense to make willful, <br />false statements or misrepresentation to any department or agency of the U.S. as to any <br />matter within its jurisdiction. <br /> <br />I/We hereby certify and affirm <br />under penalty of perjury that the above statements are true and correct. I/We promise <br />to inform the City of Redwood City of any changes in my/our status. I have no objection <br />to inquiries being made for the purpose of verifying the statements herein. <br /> <br />Signature of Applicant/ s <br /> <br />Date <br /> <br />Date <br /> <br />Received by the City of Redwood City on <br /> <br />, 199- <br /> <br />By: <br /> <br />Title: <br /> <br />27 <br /> <br />.... ",........",. ._.....,-,.,_.~--.... <br />