Moral Character Attestation Of Unlicensed Shareholder, Officer, Or Director For A Design Professional Corporation Template (Page 2 of 2) in pdf

Moral Character Attestation Of Unlicensed Shareholder, Officer, Or Director For A Design Professional Corporation Template Page 2

Attestation

I affirm under penalty of perjury that, to the best of my knowledge, all statements made in this form are true.

Signature: ________________________________________________________________________ Date: _______ / _______ / _______

mo.

day

yr.

Print Name: _______________________________________________________________________

Title (if any): _______________________________________________________________________

Social Security Number:

Home Address:

___________________________________________________________________

Home Telephone: ____________________________

E-mail address: _____________________________________________________________________

Return Directly to: New York State Education Department, Office of the Professions, Division of Professional Licensing Services,

Professional Corporations Unit, 89 Washington Avenue, Albany, NY 12234-1000.

DPC Form 1, Page 2 of 2, 1/12

Moral Character Attestation Of Unlicensed Shareholder, Officer, Or Director For A Design Professional Corporation Template Page 2