I certify that the information above is correct and truthful. I understand the consequences of fraud as described below.
Warning: Any fraudulent claims will make the consignee liable for any prosecution for mail fraud under federal crime code. The submission of a false, fictitious or fraudulent statement may result in imprisonment of up to 5 years and a fine of up to $10,000.00 (18 USC 1001). In addition, a civil penalty of up to $5,000.00, and an assessment twice the amount falsely claimed may be imposed (31 USC 3802).
THE FOREGOING STATEMENTS OF FACTS ARE HEREBY CERTIFIED AS CORRECT. |