Annual Report Template - Wyoming Public Service Commission Page 5
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5VII.
OATH AND VERIFICATION
x
STATE OF
)
)SS
COUNTY OF
)
(The Affiant), of lawful age, first being sworn. according
(NAME)
to law, upon oath hereby deposes and says that:
1. The Affiant is
(Official Title of Affiant)
of
)
(Exact legal name of reporting entity
2. Affiant has, by all necessary action, been duly authorized to make this Verification;
3. Affiant has examined the foregoing Annual Report and all attachments thereto;
4. Except as may be set forth in paragraph 5 of this Oath and Verification, Affiant hereby verifies,
upon Affiant’s knowledge, that all statements contained in the foregoing Annual Report and all
attachments thereto are true and complete and constitute a correct statement of the business
affairs of t he above-named reporting entity with respect to each and every matter set forth therein
for the period from and including January 1, 20
, to and including December 31,
20
; and,
5. State the source of Affiant’s information and grounds of Affiant’s belief as to any
matters not stated to be verified upon Affiant’s knowledge:
STATE OF
)
Signature
)SS
COUNTY OF
)
Subscribed and sworn before me this
day of
. Wi tness my hand and official seal. My
commission exp ires
)
(SEAL
Officer’s signature authorized to administer oath
6
Water Utilities
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