Connecticut Reinstatement Guarantee Declaration for Non-Stock Corporations

Reinstatement Guarantee Declaration for Non-Stock Corporations
AU-796, Reinstatement Guarantee Declaration for Non-Stock Corporations
Reinstatement Guarantee Declaration for Non-Stock Corporations
I, _________________________________________________________________, state that:
(Name)

1. I am the ____________________________________________________________ of
(Title)

_______________________________________________ and I am duly authorized to
(Name of Corporation)

execute this declaration on behalf of the corporation.

2. The corporation guarantees full payment of any accounts payable to the Commissioner

of Revenue Services that are determined to be due and are lawfully assessed against
____________________________________________________________________
(Name of Reinstating Corporation)

for any taxable period during which the company was subject to these taxes according to the
Connecticut General Statutes.

Declaration: I declare under penalty of law that I have examined this declaration (including any
accompanying schedules and statements) and, to the best of my knowledge and belief, it is true,
complete, and correct. I understand the penalty for willfully delivering a false return, statement, or
document to Department of Revenue Services (DRS) is a fine of not more than $5,000, or imprisonment
for not more than five years nor less than one year, or both. The declaration of a paid preparer other than
the taxpayer is based on all information of which the preparer has any knowledge.

__________________________ ___________________________
(Signature of Principal Officer)

AU-796 (Rev. 03/08)

(Title)

__________________
(Date)