14-18 Exhibit-Application for Discharge Site Remediation Funds from HDSRF.pdf

New Jersey Department of Environmental Protection Site Remediation Program HDSRF APPLICATION – MUNICIPAL QUESTIONNAIRE – PART VI THIS INFORMATION IS REQUIRED FOR ALL PUBLIC ENTITIES APPLICANTS In order to expedite the processing of grant or loan application for public entities at the NJEDA, complete this Preliminary Questionnaire and return it to the NJDEP as part of the HDSRF application. NJDEP will forward this information to the NJEDA once your application has been approved. If you have any questions about available financial assistance, call the NJEDA at (609) 341-2723. 1. Applicant: Township of West Orange Project Name: SELECTO FLASH INC 2. Indicate the estimated project start date. Start Date: 02/12/2018 3. List the current owner of the project site: Township of West Orange 4. If you are not the owner, do you hold a tax sales certificate for the property? .............................................. Yes No When was the tax sale certificate obtained? Date: ______________________ PROVIDE A COPY OF PROPERTY OWNERSHIP, SUCH AS TAX SALE CERTIFICATE, FORECLOSURE PAPERS, ETC. WITH THIS APPLICATION. Please see the attached foreclosure documentation. If the municipality does not currently own the property or hold a tax sale certificate, has the municipality passed a resolution indicating an intent to acquire the property? ............................................. Yes No When was the resolution passed? Date: ____________________ 5. Describe any pending or threatened litigation related to the project site. None 6. Describe any other pending issues that could delay grant/loan closing. None 7. If the financial assistance for which you are applying will not cover the full cost of your project, such as the removal of underground storage tanks, identify other funding sources: N/A Issuance of Bonds $ ____________________ Capital Budget Expenditure $ ____________________ Other, please describe: ______________________________________________________________ HDSRF Application Part VI Page 1 of 2 Version 1.3 12/11/13