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

www.ustaxcourt.gov

,

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)

This form can be filled in and printed directly from Acrobat

Reader. However, please be aware that the information

you enter on a form cannot be saved to disk unless you

are using the full Adobe Acrobat software suite.

To begin, move your mouse pointer over the Petitioner(s)

name field. Your pointer will turn into a vertical beam,

indicating that you are over an editable field. Simply click

once and begin typing. Use the Tab key to move forward

through the form fields (Shift+Tab to move backwards).