Utilities > Affidavit

Affidavit

Company Name:
Company Address
Street Address:
City:	State:	ZIP:
The Company’s D.C. gross jurisdictional revenues for the calendar year (12 months) ending December 31, 2017 are:
OATH
Affiant:
Official Title of Affiant:
Exact Legal Name of the Company:
(SEAL)
Subscribed and sworn before me this day of , 2018. Witness my hand and seal.
My commission expires