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No application can be considered complete without one. A. Individuals, firms or other legal entities with no changes to an ADEQ Disclosure Statement, complete items 1 through 5 and 18.ADEQ Disclosure Statement Form. This is a Arkansas form and can be use in Department Of Environmental Quality Statewide. The following is a listing of some of the forms and applications ADEQ offers. "Disclosure Statement" means a written statement regarding business and legal activities as defined in Ark. INSTRUCTIONS: Maintain a copy of your disclosure statement for your records. Submit the disclosure statement and supporting documentation to the address above. Submit a Disclosure Statement to ADEQ along with the permit application. The full attention of ADEQ's enforcement and legal staff.