Attachment J.6 Tax Certification Affidavit.pdf
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- Attached to
- BANKING AND DEPOSIT SERVICES & DISBURSEMENTS
- Solicitation number
- DCSC-25-RFP-127
- Issued by
- District of Columbia Government
About this file
This document is a Tax Certification Affidavit required for all bids/offers over $100,000 for the D.C. Courts. The affidavit requires bidders to certify compliance with District of Columbia tax law filings and licensing requirements, and disclose their current tax liability status.
The form mandates that bidders provide details including their state, unemployment insurance status, tax identification numbers (D.C. Employer Tax ID, Unemployment Insurance Account Number, and D-U-N-S Number), and confirm whether they are current on tax payments or have a payment agreement with relevant government departments. The document includes legal penalties for false statements, with fines up to $1,000-$2,500 and potential imprisonment of up to one to three years. The affidavit must be signed by an authorized representative, completed in full, and notarized.
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Text version
ATTACHMENT J.6
TAX CERTIFICATION AFFIDAVIT
For all bids/offers over 100,000.00, the following affidavit is required:
__________________________________, 20 ______.
I hereby certify that:
1. I have complied with the applicable tax law fillings and licensing requirements of the District of
Columbia.
2. The following information is true and correct concerning the payment of my tax liability:
State:_____________________________ Current Not Current
Unemployment Insurance_______________________ Current Not Current
3. If not current, as checked in Item 2, I am in compliance with a payment agreement with the
Department of Finance and Revenue Yes No, and/or the Department of
Employment Services Yes No.
4. My tax numbers are as follows:
D.C. Employer Tax ID No.: _______________________________________________
Unemployment Insurance Account No.:_______________________________________
D-U-N-S No.:____________________________________________________________
The D.C. Courts is hereby authorized to verify the above information with appropriate Government authorities. Penalty of making false statements is a fine of not more than $1,000.00, imprisonment for not more than one (1) year or both, as prescribed in D.C. Code Sec. 22-2514. Penalty for false swearing is a fine of not more than $2,500.00, imprisonment for not more than three (3) years, or both, as prescribed in D.C. Code Sec. 22-2513.
Signature of Person Authorized to Sign Title
This Document
Typed or Printed Name
Name of Organization __________________________________________________________
Notary: Subscribed and sworn before me this __day of ________________, 20 at
___________________________ at ___________________________________
Month and Year City and State
File details come from the government source that posted it. Updated .