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RELOCATION NEEDS ASSESSMENT FORM <br />PAGE 6 <br />* * * ** *PLEASE READ AND SIGN BELOW * * * * ** <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 />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 />Signature of Applicant /s <br />Date <br />Date <br />Received by the City of Redwood City on , 199_ <br />M <br />Title: <br />s <br />