(c) Applications for reimbursements shall include the following information:
(1) An itemized statement of the following:
- (i) The total expenses incurred by the municipality in performing duties in compliance with the act.
- (ii) The total amount of fees collected by the municipality as part of its stormwater review or regulation activities in performing its duties under the act.
- (iii) The difference between expenses incurred and income relating to stormwater activities received by the municipality.
- (iv) The amount of reimbursement being requested.
- (2) A certification as to the accuracy of the information being submitted by the chief executive officer of the municipality and the individual who prepared the statement.