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I do solemnly declare and certify under the penalty of law
that the within bill is correct in all its particulars, the
articles have been furnished or services rendered as
stated herein, that no bonus has been given or received by
any person or persons within the knowledge of this
claimant in connection with the above claim, and that the
amount charged is a reasonable one.
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Just send your check with the application form!
You do not need to send us your voucher for a
separate signature since the pre-signed
certification at the left can be attached to your
voucher in lieu of sending another one
for signature. This form has been determined by
the Division of Local Government Services
to meet the requirements of the statutes
for this type of expenditure.
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