Section 38.2-1342 Report - Commonwealth Of Virginia Page 3
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3CERTIFICATION
I hereby certify under penalty of perjury that the foregoing statements and information appearing in
Sections I and _______ (enter II or III, whichever is appropriate) are true and correct to the best of my
knowledge and belief.
Dated and signed this ______ day of _____________, 20_____ at _________________________.
__________________________________________________, being duly sworn according to law,
(Name of Officer)
deposes and says that the answers to the questions and the declarations contained in this report are true and
correct.
______________________________ ____________________________________
(Signature of Officer)
(Title)
Section 38.2-1342 Report
Page 3 of 3
R08 (10/16)
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