I/We have read the above and foregoing Application for Assistance and declare under penalties of perjury that to the best of my/our knowledge and belief the information supplied in this Application and all accompanying statements and documents is true and correct and that it is a complete statement of all income, assets, and resourcesbelonging to me/us and the members of my/our family on whose behalf I am/we are requesting assistance. I/We agree to notify the Township Supervisor of any change whatsoever in need or in the resources listed herein or of any new or additional income or resources. Further, by my/our signature(s) I/we hereby authorize any person, bank, corporation, transfer agent, agency, institution, or the Department of HHS to furnish to the Township Supervisor whatever information the Supervisor may request relative to accounts, deposits, investments, securities, RSDI benefits or business of any kind whatsoever. I/We acknowledge that by entering my/our name(s) below and clicking "Submit Application", I am/we are indicating my/our intent to sign this Application for Assistance and that this shall constitute my/our signature(s). I/We acknowledge that I/we must come to the Geneva Township offices for an interview at which time I/we will be required to sign a printed copy of this application.