Tax_Certification_Affidavit-_Attachment_J_2.pdf

ATTCHMENT J.2

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: Dcurrent D Not Current

Un em p 1 o ym en t Insurance _________ _ 0 Current O Not Current

3. If not current, as checked in Item 2, I am in compliance with a payment agreement with the Departrnent of Finance and Revenue D Yes D No, and/or the Department of Employment Services D Yes D 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.

Signarure of Person Authorized to Sign This Document

Typed or Printed Name

Title

Name of Organization

Notary: Subscribed and sworn before me this day of , 20 at at

Month and Year City and State