Form St-21pec - Sales And Use Tax Refund Application For Use By Pec Entities (Page 3 of 5) in pdf

Form St-21pec - Sales And Use Tax Refund Application For Use By Pec Entities Page 3

PART IV –

Affidavit of Contractor’s Owner or Corporate Officer

AFFIDAVIT

I certify under penalties of perjury that:

(a) to the best of my knowledge, all of the information and statements made in

this Affidavit are true and correct,

(b) all of the taxes included in this Affidavit were paid to vendors or accrued by the

contractor; and,

same taxes included in this Affidavit.

__________________________________________________________________

________________________

Affiant’s Signature

Date

STATE OF KANSAS

)

SS:

)

COUNTY OF ________________________________

)

This Contractor Affidavit was acknowledged before me on ______________________________________ , 20 _____ by

_________________________________________________________ as __________________________________ .

Name of Affiant

Official Capacity (owner, officer, partner, etc.)

Notary Public: ________________________________

My appointment expires: _______________________________

Form St-21pec - Sales And Use Tax Refund Application For Use By Pec Entities Page 3