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Residential Emergency Repair Program <br /> Certification of Non-Filing of State Income Tax Return <br /> Name: <br /> Name: <br /> Address: <br /> STATE OF HAWAII ) <br /> SS: <br /> COUNTY OF HAWAII ) <br /> The undersigned hereby certify that the borrower(s), pursuant to the laws and regulations as <br /> established by the State of Hawaii Department of Taxation, did not file a State Income Tax Return for the <br /> tax year , and that the borrower(s) understand that misrepresentation of information or <br /> failure to disclose information will constitute just cause for the County to call the loan immediately due <br /> and payable. <br /> BORROWER <br /> BORROWER <br /> Subscribed and sworn to before me <br /> this day of , 20 <br /> Notary Public, State of Hawai'i <br /> My commission expires: <br />