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ORANGE COUNTY LAFCO Project Application Form <br />Page 4 of 12 <br />❑ LAFCO Disclosure Form (please complete LAFCO Disclosure of Political <br />Expenditures, Attachment 3); copy of Financial reports and disclosures submitted to <br />FPPC (please attach) <br />❑ Please check here if you have no related financial reports or disclosures. <br />INDEMNIFICATION AGREEMENT: <br />LAFCO policy requires that all applicants sign an indemnification agreement (see Attachment 2) <br />which indemnifies LAFCO employees, agents and attorneys in the event of litigation is filed <br />concerning the approval of an application. <br />The following is included with this application form: <br />❑ Signed Indemnification Agreement <br />FILING FEES: <br />Applicants are required to pay fees in accordance with OC LAFCO's adopted fee schedule (see <br />Attachment 4) to cover the administrative and staff costs required to evaluate proposals for <br />hearing. Checks must be made payable to: "Orange County LAFCO". <br />The following is included with this application form: <br />❑ Check for Filing Fees <br />❑ Other (explain why Filing Fees not included): <br />CERTIFICATION <br />I certify, under penalty of perjury by the laws of the State of California, that the information <br />contained in this application is true and correct. I acknowledge and agree that the Orange <br />County Local Agency Formation Commission is relying on the accuracy of the information <br />provided and my representations in order to process this application proposal. <br />Signature: <br />Name: <br />Title: <br />Date: <br />(The information contained in this application maybe subject to disclosure under the California Public Records Act Covertement <br />Code Section 6250 et seq.) <br />65F-10 <br />