1. SAMPLE AFFIDAVIT OF SOLE OFFICER

2500-FM-BWM0613 10/2013
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF ENVIRONMENTAL PROTECTION
BUREAU OF WASTE MANAGEMENT
 
 
 
 

 
 
        
SAMPLE AFFIDAVIT OF SOLE OFFICER
(Corporations Must Use This)
Date:      
Department of Environmental Protection
Division of Contracts, Procurement & Bonding
15TH Floor, Rachel Carson State Office Building
400 Market Street
P. O. Box 8766
Harrisburg, PA 17105-8766
Dear      
The undersigned affiant       swears and affirms that he/she is the sole officer of      
located at      ; that no other person, firm, association, partnership or corporation is entitled to the funds of said Company; that he/she has the authority to execute any note, mortgage, evidence of indebtedness, contract or other document or any assignment or endorsement thereof, for and on behalf of the said corporation and that he/she will notify the Department of Environmental Protection at any time that such office shall cease or be changed in any manner whatsoever.
  
Signature:
Typed Name:      
Typed Title(s):      
  
State of      
County of      
Subscribed and sworn to before me, a Notary Public in and for the above County and State this       day of
      , 20     
 
 
Notary Public:
 
My Commission expires      

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