"Sworn Statement" - Pennsylvania

Sworn Statement is a legal document that was released by the Pennsylvania Department of Banking and Securities - a government authority operating within Pennsylvania.

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Download "Sworn Statement" - Pennsylvania

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MARKET SQUARE PLAZA | 17 N SECOND STREET, SUITE 1300 | HARRISBURG, PA 17101-2290
717.787.2665
717.787.8773
www.banking.state.pa.us
Ph
Fx
W
SWORN STATEMENT
Section 711(b) of the Pennsylvania Credit Union Code, which became effective February 17, 1991,
mandates that every officer, director, committee member and employee shall sign a sworn statement
disclosing whether he/she has ever been convicted of a misdemeanor or a felony involving dishonesty,
breach of trust or violation of this title.
1.
State whether you have ever been convicted of a misdemeanor or felony involving dishonesty,
breach of trust or violation of the Pennsylvania Credit Union Code.
Yes
No
2.
If “Yes”, please furnish complete details concerning dates, location, nature of crime, disposition,
etc.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
:
COUNTY OF
: SS.
I,
being duly sworn according to law, dispose and
say that the statements contained in the above are true and correct.
Signature
(Seal)
Sworn and subscribed before me this
day of
in the year
.
(Notary Public)
MARKET SQUARE PLAZA | 17 N SECOND STREET, SUITE 1300 | HARRISBURG, PA 17101-2290
717.787.2665
717.787.8773
www.banking.state.pa.us
Ph
Fx
W
SWORN STATEMENT
Section 711(b) of the Pennsylvania Credit Union Code, which became effective February 17, 1991,
mandates that every officer, director, committee member and employee shall sign a sworn statement
disclosing whether he/she has ever been convicted of a misdemeanor or a felony involving dishonesty,
breach of trust or violation of this title.
1.
State whether you have ever been convicted of a misdemeanor or felony involving dishonesty,
breach of trust or violation of the Pennsylvania Credit Union Code.
Yes
No
2.
If “Yes”, please furnish complete details concerning dates, location, nature of crime, disposition,
etc.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
:
COUNTY OF
: SS.
I,
being duly sworn according to law, dispose and
say that the statements contained in the above are true and correct.
Signature
(Seal)
Sworn and subscribed before me this
day of
in the year
.
(Notary Public)