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138 <br /> <br />(10) <br /> <br />determination of the license tax for the particular <br />business referred to in the application, such items must <br />be stated on the application; provided that a newly <br />established business shall make a true estimate or <br />statement of such information and the business tax shall <br />be based upon said estimation and shall be paid at the <br />time such license is issued. <br /> <br />Any further information which the Collector may require <br />to enable him to issue the type of license applied for; <br /> <br />(11) <br /> <br />(12) <br /> <br />Any further information which the state may require, or <br />any further information which the Collector may deem <br />necessary to properly identify the applicant. <br />A signed statement made under penalty of perjury that the <br />statements therein are true and correct, which statement <br />shall be required to be filed with the Collector upon <br />submiss ion of any or iginal 1 icense appl tcat ion, annual <br />renewal statement, miscellaneous supplementary statement, <br />or other return or filing. Each such declaration of <br />truth of application or statement shall have included <br />therein, or attached thereto, a certification or <br />declaration, which shall be substantially in the <br />following form: <br /> <br />"I declare, under penalty of perjury; that this <br />application, return or statement (including any <br />accompany lng schedules, statements, and supporting data) <br />has been examined by me, and, to the best of my <br />knowledge, information, and belief, is a full true and <br />correct, application, return, or statement and I <br />accordungly so represent. <br /> <br />Signature of Owner, or Partner, or Officer of <br />Corporation, or Other Authorized Agent or <br />Representative of any of the above said same." <br /> <br />Date <br /> <br /> All information specified to be set forth on any application <br />form prescribed by the Collector shall be submitted completely <br />and accurately and the license shall be deemed based upon the <br />information submitted and represented. The Collector shall not <br />be required to receive or consider, any application, return or <br />statement unless the above quoted declaration, in substantially <br />the form here inabove set forth, is contained therein or attached <br />thereto and properly executed by the applicant or the authorized <br />agent or representative of the applicant, and it is unlawful and <br />shall be deemed a misdemeanor in any such application, return or <br />statement for such applicant or authorized agent or <br />representative of the applicant to make any statement which is <br />false or which is contrary to the declaration or representation <br />made in the above quoted form. ~ <br /> <br />- 38 <br /> <br /> <br />