Tax Certification Affidavit - Government Of The District Of Columbia

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GOVERNMENT OF THE DISTRICT OF COLUMBIA
OFFICE OF THE CHIEF FINANCIAL OFFICER
OFFICE OF TAX AND REVENUE
TAX CERTIFICATION AFFIDAVIT
THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE
REGISTERED TO CONDUCT BUSINESS IN THE DISTRICT OF COLUMBIA.
Date: __________________________________________________________________
Name of Organization/Entity: _______________________________________________
Address:
Business Telephone No.:
Principal Officer:
Name: _______________________ Title:_____________________________________
Social Security No.:________________________________________
Federal Identification No.:__________________________________________________
Contract No.: ___________________________________________________________
Unemployment Insurance Account No.:
I hereby certify that:
1. I have complied with the applicable tax filing and licensing requirements of the
District of Columbia.
2. The following information is true and correct concerning tax compliance for the
following taxes for the past five (5) years:
Current
Not Current
Not Applicable
District:
Sales and Use
(
)
(
)
(
)
Employment Withholding
(
)
(
)
(
)
Ballpark Fee
(
)
(
)
(
)
Corporation Franchise
(
)
(
)
(
)
Unincorporated Franchise
(
)
(
)
(
)
Personal Property
(
)
(
)
(
)
Real Property
(
)
(
)
(
)
Individual Income
(
)
(
)
(
)

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