1. (a) The applicant shall sign and date the pre-approval request and print their name.

2. (b) The applicant shall certify that:

   1. (1) The information provided is true, not misleading, and as complete as practicable, to the best knowledge and belief of the applicant;
   2. (2) The applicant understands that any department determination that the applicant and the applicant’s request qualifies for pre-approval from the program that is found to be based upon false, incomplete, or misleading information is subject to modification or reversal, through an adjudicative proceeding conducted in accordance with applicable provisions of Env-C 200; and
   3. (3) The applicant acknowledges that they might be subject to the penalties for false statements, including those penalties, specified in RSA 641 for falsification in official matters.

Source. #14201, eff 2-26-25