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Residential Emergency Repair Program <br />Certification of Non-Filing of Federal Income Tax Return <br />Name:_______________________________ <br />Name:_______________________________ <br />Address:_____________________________ <br />_____________________________ <br />STATE OF HAWAI'I ) <br /> ) SS: <br />COUNTY OF HAWAI'I ) <br /> The undersigned hereby certify that the borrower (s), pursuant to the laws and regulations as <br />established by the United States Internal Revenue Service (IRS), did not file a Federal Income Tax <br />Return for the tax year __________, and that the borrower (s) understand that misrepresentation of <br />information or failure to disclose information will constitute just cause for the County to call the loan <br />immediately due and payable. <br />___________________________________ <br />BORROWER <br />___________________________________ <br />BORROWER <br />Subscribed and sworn to before me <br />this_______ day of ________________, 20_____ <br />________________________________________ <br />Notary Public, State of Hawai'i <br />My commission expires:_____________________ <br /> <br />