If the applicant is a sole proprietor, social security number verification will be requested at a later time if the application is granted further consideration.

The following questions are for gathering statistical data only. If the business is owned and controlled primarily by individuals who are identified in any of the following categories, please check all the categories that apply:

I HEREBY AFFIRM THAT I am a duly authorized representative of the Business and that I possess the legal authority to make this Affidavit on behalf of myself and the business for which I am acting.

The business named above is registered in accordance with the Corporations and Associations Article, Annotated Code of Maryland, and that it is in good standing and has filed all of its annual reports, together with filing fees, with the Maryland State Department of Assessments and Taxation,

Except as validly contested, the business has paid, or has arranged for payment of, all taxes due to all government entities including the State of Maryland, and has filed all required returns and reports with the Comptroller of the Treasury, the State Department of Assessments, and Taxation, the Department of Labor, Licensing and Regulation (DLLR), and all other taxing authorities, as applicable, and will have paid all withholding taxes due to the State of Maryland and all other government entities prior to final settlement.

•    I further affirm that I have incurred financial losses caused directly or indirectly by the COVID-19 public health emergency.

•    I further affirm that funds received from the Personal Services E-Business Grant will not be used for the same purpose and time period as funds received from federal, state, or municipal relief programs.

•    I further affirm that there no outstanding, pending, or anticipated claims or litigation against my company.

•    I further affirm that I am not personally in bankruptcy or the business is currently in bankruptcy.

•    I attest that the financial information provided in this application matches the tax return filed with the Internal Revenue Services (IRS).

•    I attest that I have filled the submitted tax returns with the Internal Revenue Services (IRS)

All information in this application and in the attached exhibits, attachments, and addendums are true and complete to the best of my/our knowledge, information, and belief. The undersigned agrees that the tax information provided to the County is identical to what was submitted to the IRS. Further, I/we agree not to engage in employment practices that deny equal employment rights to persons by reason of (i) political or religious opinion or affiliation, marital status, race, color, creed or national origin; (ii) sex or age, except when sex or age constitutes a bona fide occupational qualification; or (iii) physical or mental disability of a qualified individual with a disability. I/we agree to comply with the State’s policy of maintaining a drug and alcohol-free workplace. I/We hereby authorize all involved in the financing of this project to exchange freely without further authorization and consent, any and all financial information and reports provided in connection with this application and the processing of the loan request.

The undersigned agrees that banks, credit agencies, State agencies, IRS, and other sources are hereby authorized now, or anytime in the future, to give Prince George’s County, or their assigns and successors, any and all information in connection with matters addressed in this application, including information concerning the payment of taxes and credit information by the applicant.

Each of the undersigned agrees to notify us immediately, and in writing of any change in name, address, or employment of any material adverse change (1) in any of the information contained in these statements or (2) in the financial condition of any of the undersigned or (3) in the ability of any other undersigned to perform its (or their) obligations to us. In the absence of such notice or a new and full written statement, this should be considered as a continuing statement and substantially correct. If the undersigned fail(s) to notify us as required above, or if any of the information herein or in the statement should prove to be inaccurate or incomplete in any material respect, we may declare the indebtedness of the undersigned or the indebtedness guaranteed by the undersigned, as the case may be, immediately due and payable.

Photo, Video & Print Release Form; I, the undersigned, hereby give my permission to the Prince George’s County Economic Development Corporation (PGCEDC), its agents and employees, to print, publish, videotape, reproduce, or otherwise use my name, photograph, or photographs, and any descriptive text regarding my participation in this program in a publication or publications to be disseminated publicly by PGCEDC to publicize and promote PGCEDC activities in Prince George’s County and the State of Maryland. In order to participate in this promotional effort, I hereby release and agree to hold harmless and indemnify PGCEDC from any and all rights, claims, or interest which I may have or which may arise as a result of PGCEDC publication of my name, photographic likeness (print, video or electronic), or other personal information for the purposes above-described, and I agree to hold harmless and indemnify Prince George’s County from any and all claims concerning my participation in the promotional effort by third parties relating thereto.