Form 6326 - Alaska Certificate Of Qualifying Veteran printable pdf download

Form 6326 - Alaska Certificate Of Qualifying Veteran

Alaska Certificate of Qualifying Veteran

6326

Form

Complete and provide to employer

Social Security Number

Name of Veteran

Telephone Number

Mailing Address

City

State

Zip Code

Purpose of form: The certificate of qualifying veteran declares that the person qualifies as a veteran under AS 43.20.048 for purposes

of the employer claiming a veteran employment tax credit

Required attachment: You must attach a copy of your federal Certificate of Discharge (DD-214 or other)

I certify the following (check the box of each item that applies):

I served in and was honorably discharged from one of the following:

the armed forces of the United States, including a reserve unit of the armed forces of the United States

Alaska Territorial Guard, the Alaska Army National Guard, the Alaska Air National Guard, or the Alaska Naval Militia

I have been unemployed for at least 4 weeks immediately preceding the date employment begins

I am a disabled veteran because I am one of the following:

a veteran who is entitled to compensation under laws administered by the United States Department of Veterans Affairs

a person who was honorably discharged or released from activity duty because of service-connected disability

a person who was disabled in the line of duty while serving in the Alaska Territorial Guard

Veteran’s sworn statement: The undersigned understands that the fraudulent use of this certificate will subject all guilty parties, upon

conviction, to a fine not to exceed $25,000 or imprisonment for not more than three years, or both, under AS 43.05.290.

I swear under penalty of perjury that I have examined this certificate and to the best of my knowledge and belief, it is a true, correct and

complete statement.

Veteran’s Signature

Date

0405-6326 Rev 01/01/14

6326:01 01 14

Form 6326 - Alaska Certificate Of Qualifying Veteran