SWORN STATEMENT OF NATIONALITY
I, ______________________________________, hereby swear and affirm that I
am / am not a foreign legal entity or foreign person, as those terms are defined in the
Higher Education Gift Disclosure Act, 24 P.S. § 6302, as follows.
“Foreign legal entity”
(1) Any legal entity created under the laws of a foreign government.
(2) Any legal entity created under the laws of the United States or of any state or
political subdivision thereof if:
(i) fifty percent of the ownership of the stock of, or interest in, such legal
entity is directly or indirectly owned legally or beneficially by one or
more foreign governments or one or more foreign persons;
(ii) fifty percent of the membership of any such entity is composed of
foreign persons or legal entities created under the laws of a foreign
government or agents of such legal entities; or
(iii) fifty percent of the assets of such entity are derived from contributions
or loans from foreign persons.
Any foreign legal entity and any individual who is not a citizen or national of the
United States or a trust territory protectorate thereof. The term shall include an
agent of such individual.
I hereby declare that the above statement is true and that the statement is made
subject to the penalties prescribed in 18 Pa.C.S. §4904(b) (relating to unsworn
falsification to authorities).
Donation made to: ______________________________________________________
Name of college/university
PDE-6003 Revised March 2015