Form 5 "Attestations" - New York

What Is Form 5?

This is a legal form that was released by the New York State Department of Environmental Conservation - a government authority operating within New York. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • The latest edition provided by the New York State Department of Environmental Conservation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form 5 by clicking the link below or browse more documents and templates provided by the New York State Department of Environmental Conservation.

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Download Form 5 "Attestations" - New York

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Form 5: Attestations
I certify that the undersigned is authorized to make these attestations on behalf of the Accredited
Verifier. I am authorized to make this submission on behalf of the Accredited Verifier for which
the submission is made. I certify under penalty of law that I have personally examined, and am
familiar with, the statements and information submitted in this document and all its attachments.
Based on my inquiry of those individuals with primary responsibility for obtaining the information,
I certify that the statements and information are to the best of my knowledge and belief true,
accurate, and complete. I am aware that there are significant penalties for submitting false
statements and information or omitting required statements and information, including the
possibility of fine or imprisonment.
Signature of Authorized Representative
Date
Name in Print
Title
Sworn and subscribed before me on this
day of
, 200
Notary Public
Form 5: Atttestations
Accredited Offset Verifier Pre-Engagement Disclosure Submittal
Version NY-1.0
Page 1 of 1
Form 5: Attestations
I certify that the undersigned is authorized to make these attestations on behalf of the Accredited
Verifier. I am authorized to make this submission on behalf of the Accredited Verifier for which
the submission is made. I certify under penalty of law that I have personally examined, and am
familiar with, the statements and information submitted in this document and all its attachments.
Based on my inquiry of those individuals with primary responsibility for obtaining the information,
I certify that the statements and information are to the best of my knowledge and belief true,
accurate, and complete. I am aware that there are significant penalties for submitting false
statements and information or omitting required statements and information, including the
possibility of fine or imprisonment.
Signature of Authorized Representative
Date
Name in Print
Title
Sworn and subscribed before me on this
day of
, 200
Notary Public
Form 5: Atttestations
Accredited Offset Verifier Pre-Engagement Disclosure Submittal
Version NY-1.0
Page 1 of 1