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Sworn Statement
I hereby swear and affirm under penalty of perjury that all documents, logs, worksheets, receipts, and information uploaded with this submission are a true, accurate, and complete to the best of my knowledge for the stated tax year. I certify that the name provided on the previous page is my legal name and that this statement is true and correct.
Tax Year
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By signing below, I certify this statement is true and correct under
penalty of perjury.
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Day
Year
Date
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