Final_Tax_Certification_Affidavit-NEW.pdf
PDF 94 KB Posted
- Attached to
- ATM SERVICES
- Solicitation number
- 25-S-022
- Issued by
- District of Columbia
About this file
This is a Tax Certification Affidavit document issued by the Government of the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue, required for the ATM Services contract opportunity with Events DC (Washington Convention and Sports Authority). The affidavit serves as a compliance verification tool for organizations seeking to enter into contractual relationships with District of Columbia agencies. Completion of this form is mandatory only for entities registered to conduct business in the District of Columbia and must include authorization for the Office of Tax and Revenue to release tax compliance information to the contracting agency, certification of compliance with applicable District tax filing and payment requirements, and signature of an authorized agent or principal officer.
The affidavit requires collection of standard business identification information including organization name, business address, phone number, federal identification number, unemployment insurance account number, square and lot information, and contract number. The authorization granted through this affidavit remains valid for one year from the date of signature. False certification on this form carries significant penalties, including fines up to $5,000, imprisonment up to 180 days, or both, as prescribed by D.C. Official Code 47-4106. The Office of Tax and Revenue is authorized to verify the provided information with appropriate government authorities to confirm the applicant's eligibility for contract award.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Chief Financial Officer Office of Tax and Revenue
Authorized Agent Name of Organization/Entity Business Address (include zip code) Business Phone Number
I hereby authorize the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue to release my tax information to an authorized representative of the District of Columbia agency with which I am seeking to enter into a contractual relationship. I understand that the information released will be limited to whether or not I am in compliance with the District of Columbia tax laws and regulations solely for the purpose of determining my eligibility to enter into a contractual relationship with a District of Columbia agency. I further authorize that this consent be valid for one year from the date of this authorization.
I hereby certify that I am in compliance with the applicable tax filing and payment requirements of the District of Columbia. The Office of Tax and Revenue is hereby authorized to verify the above information with the appropriate government authorities.
TAX CERTIFICATION AFFIDAVIT
Date
Office of Tax and Revenue, PO Box 37559, Washington, DC 20013
THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE REGISTERED TO CONDUCT BUSINESS IN
THE DISTRICT OF COLUMBIA.
Authorized Agent Principal Officer Name and Title Square and Lot Information Federal Identification Number Contract Number Unemployment Insurance Account No.
Signature of Authorizing Agent Title
The penalty for making false statement is a fine not to exceed $5,000.00, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code §47-4106.
GOVERNMENT OF THE DISTRICT OF COLUMBIA
Office of the Chief Financial Officer Office of Tax and Revenue
I hereby authorize the District of Columbia, Office of the Chief Financial Officer, Office of Tax and Revenue to release my tax information to an authorized representative of the District of Columbia agency with which I am seeking to enter into a contractual relationship. I understand that the information released will be limited to whether or not I am in compliance with the District of Columbia tax laws and regulations solely for the purpose of determining my eligibility to enter into a contractual relationship with a District of Columbia agency. I further authorize that this consent be valid for one year from the date of this authorization.
I hereby certify that I am in compliance with the applicable tax filing and payment requirements of the District of Columbia. The Office of Tax and Revenue is hereby authorized to verify the above information with the appropriate government authorities.
TAX CERTIFICATION AFFIDAVIT
Office of Tax and Revenue, PO Box 37559, Washington, DC 20013 THIS AFFIDAVIT IS TO BE COMPLETED ONLY BY THOSE WHO ARE REGISTERED TO CONDUCT BUSINESS IN THE DISTRICT OF COLUMBIA.
The penalty for making false statement is a fine not to exceed $5,000.00, imprisonment for not more than 180 days, or both, as prescribed by D.C. Official Code §47-4106.
8.2.1.4029.1.523496.503679
| TextField4: |
| TextField1: |
| SignatureField1: |
File details come from the government source that posted it. Updated .