Form Wv/cem-4 - Preneed Cemetery Company Annual Report

Form Wv/cem-4 - Preneed Cemetery Company Annual Report - 1999 Page 3

13.

CERTIFICATION OF COMPLIANCE AGENT

I certify that for the specified reporting period this trust account is in compliance with all applicable

provisions of Article 5B, Chapter 35 of the Code of West Virginia of 1931, as amended, and of Series 36,

Title 110 of the West Virginia Code of State Rules.

_______________________

Signature of Compliance Agent

Taken, subscribed, acknowledged and sworn to before me this _____day of __________________, 19____.

My commission epires on_________________________________________________________________.

_______________________

Notary Public

(NOTARY SEAL)

14.

CERTIFICATION OF CERTIFIED PUBLIC ACCOUNTANT

I have audited this trust account and certify that according to all information provided to me in the course of

completing the audit, at least 40% of the cash receipts from the sale of preneed property, goods and services

which was not anticipated to be delivered or performed within 120 days after receipt of the initial payment on

account has been deposited in the account within 30 days after the close of the month in which such

payments were received, all as required by West Virginia Code §35-5B-10.

Signature of Certified Public Accountant . . . . . . . . . . . . . . . . . ___________________________________

Typed/Printed Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ___________________________________

Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ___________________________________

___________________________________

Taken, subscribed, acknowledged and sworn to before me this ____ day of ___________________, 19____.

My commission expires on ________________________________________________________________

________________________

Notary Public

(NOTARY SEAL)

Form Wv/cem-4 - Preneed Cemetery Company Annual Report - 1999 Page 3