Dissolution of Public and Association Libraries in New York State

S A M P L E
AFFIDAVIT REGARDING TAXES

NOTE: THIS IS A SAMPLE DOCUMENT ONLY. PLEASE FOLLOW THIS FORMAT AND THE INSTRUCTIONS IN PARENTHESES ( ) WHEN DRAFTING YOUR OWN PETITION. PLEASE BE SURE TO HAVE THE NOTARY PUBLIC INCLUDE A COMPLETE ACKNOWLEDGMENT OF THE SIGNATURES ON THE PETITION, INCLUDING AN ACKNOWLEDGMENT STATEMENT AND HIS/HER STAMP AND SIGNATURE. IF THE SIGNATURES ARE ACKNOWLEDGED SEPARATELY, EACH ACKNOWLEDGMENT MUST INCLUDE THE STATEMENT, STAMP AND SIGNATURE.

This document in MS Word format pdf file [37K]

______________ and _______________ after having been duly sworn, depose and state as follows:

They are the President and Secretary, respectively, of ____________________________________;

Any and all taxes payable by the corporation have been paid and no taxes are now due or accrued from the corporation.

_______________________________
Signature

_______________________________
Typed name/title/address of officer

_______________________________
Signature

______________________________
Typed name/title/address of officer



STATE OF NEW YORK       )
                        ss:
COUNTY OF       )

On the ________ day of _____________ 20___, before me personally came (insert names of officers), to me known to be the persons described in and who executed the foregoing application, and they severally duly acknowledged to me that they executed the same.

(Typed name, stamp and signature of notary public)

Last Updated: August 31, 2009