Applicant’s Release & Certification: I verify that all the statements I have made in this application are true and accurate to the best of my ability. I understand that Age Friendly Seattle shall have the right and opportunity to verify my eligibility for a FLASH or GOLD Card. I understand that if any of the statements made on this application form are false or inaccurate, I will lose the privileges granted by the FLASH/GOLD Card and may be subject to criminal prosecution in accordance with Washington State Law for theft (RCW 9A.56.020). *