Unsworn Declaration Under Penalty of Perjury

• Legal Form Number: 18
• Section: Tax Court
• Court: U.S. Tax Court

UN ITED STA TES T AX COUR T

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,

Pe titione r(s)

v.

CO MMIS SION ER O F INT ERN AL RE VEN UE,

Respond ent

Docket N o.

UN SWO RN D ECLA RATI ON U NDER PEN ALT Y OF PERJ URY

I, , declare from my p ersonal knowledge that the following facts

are true:

[Sta te the facts in as m any nu mbere d par agrap hs as a re nee ded. Attac h add itiona l page s if nec essar y.]

1.

2.

3.

4.

5.

I de clare under pena lty of p erjur y that the for egoin g is tr ue and corr ect. E xecut ed on .

[Signature]

OR

[If t he de clarati on is execut ed out side o f the U nited State s:]

I de clare under pena lty of p erjur y unde r the laws o f the U nited States of Am erica that th e foreg oing is true and c orrec t.

Executed on .

[Signature]

T.C. FORM 18 (07/12)

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