I affirm that any business list information obtained from the Department of State will not be used in any manner that may result in harm to the personal, physical or financial security of any individual; to harass or threaten any individual or association; or for any other illegal or improper purpose. I verify that this statement is true and correct. I understand that false statements made are subject to the penalties of 18 Pa.C.S. § 4904 (relating to unsworn falsification to authorities).