Tax Certification Affidavit - Government Of The District Of Columbia Page 2
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2Tax Certification Affidavit
Page 2
The Office of Tax and Revenue is hereby authorized to verify the above information
with the appropriate government authorities. The penalty for making false
statements is a fine not to exceed $5,000.00, imprisonment for not more than 180
days, or both, as prescribed by D.C. Official Code § 47-4106.
This affidavit must be notarized and becomes void if not submitted within 90 days
of the date notarized.
____________________________
____________________________________
Signature of Authorizing Agent
Title
_______________________________________________
Print Name
Notary:
DISTRICT OF COLUMBIA, ss:
Subscribed and sworn before me this ___________ day of _________________Month
and Year
Notary Public: ___________________________________________________________
My Commission
Expires:_________________________________________________________________
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