Form Char010 - Certification To Accompany Reports Submitted On Forms Other Than Official Department Of Law (Attorney General) Forms

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CHAR010
STATE OF NEW YORK
DEPARTMENT OF LAW
Certification to Accompany Reports Submitted
CHARITIES BUREAU - REGISTRATION SECTION
on Forms Other than Official Department of
120 BROADWAY
Law (Attorney General) Forms
NEW YOR K, NY 10271
Attorney General's registration number:
Name of Registrant:
Mailing Address:
Tel. No.:
Fax. No.:
Email Address
I (We) certify, under penalty for perjury, that the following documents (list submitted documents) attached
hereto:
all of which comprise the 20
(insert year of report) periodic report of (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 and TITLE (printed)
Signature
Tel. No.:
Fax. No.:
Email Address
Dated the
day of
, 20
NAME and TITLE (printed)
Signature
Tel. No.:
Fax. No.:
Email Address
Dated the
day of
, 20
CHA R010
(Rev. 10/02)

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