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