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ORANGE COUNTY LAFCO Project Application Form Page 4 of 9 A map and legal description has been: ❑ Certified by the County Surveyor and is attached to this application. ❑ Submitted for review to the County Surveyor. ❑ Other (please explain) N/A. The City is processing a small island annexation request. Orange County LAFCO requires applicants to report all expenditures for political purposes related to an application and proceedings to be reported to the Commission's Executive Officer in compliance with Government Code Sections 56700.1 and 57009. The following is attached to this application form: ❑ LAFCO Disclosure Form (please complete LAFCO Disclosure of Political Expenditures, Attachment 3); copy of Financial reports and disclosures submitted to FPPC (please attach) ❑ Please check here if you have no related financial reports or disclosures. LAFCO policy requires that all applicants sign an indemnification agreement (see Attachment 2) which indemnifies LAFCO employees, agents and attorneys in the event of litigation is filed concerning the approval of an application. The following is included with this application form: ❑ Signed Indemnification Agreement FILING FEES: Applicants are required to pay fees in accordance with OC LAFCO's adopted fee schedule (see Attachment 4) to cover the administrative and staff costs required to evaluate proposals for hearing. Checks must be made payable to: "Orange County LAFCO': The following is included with this application form: ❑ Check for Filing Fees ❑ Other (explain why Filing Fees not included): As the County island is less than 150 acres in size, the OC LAFCO Commission will waive the application fees. ('rha w1brmation contained !n this application may be subject to diselosurc under lte California Public Records Act GovernownI Corse Section 6250 et seq.) ._ 75C-17