Form Char010 - Certification To Accompany Reports Submitted On Forms Other Than Official

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Charities Form 010
Page 1 of 1
CHAR010
CERTIFICATION TO ACCOMPANY REPORTS SUBMITTED ON FORMS OTHER THAN OFFICIAL
ATTORNEY GENERAL REPORT FORMS
The following certification shall accompany reports submitted on forms other than official Attorney General report forms:
State of
)
:
SS.:
County of
)
I(We) swear under oath that the following documents attached hereto:(list submitted documents)
all of which comprise the 19___ (insert year of report) periodic report for
______________________________________________________ (insert legal name of organization)
have been examined by me (us) and to the best of my (our) knowledge and belief the contents thereof are true, correct and
complete.
_____________________________________________________________________
Name Printed
Signature
Title
_____________________________________________________________________
Name Printed
Signature
Title
_____________________________________________________________________
Name Printed
Signature
Title
Sworn to before me this
____ day of ____________, 19___
___________________________
NOTARY PUBLIC
CHAR010 1/99
3/3/00

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