OATH OF NOT FOR PROFIT STATUS
| Contractor: | Contract Number: |
As an authorized representative for the Contractor identified herein, and in the above referenced document(s), I do hereby swear under oath that this entity is currently a “not for profit” (non-profit) organization as defined in Section 501(c)(3) of the Internal Revenue code.
If this non-profit status changes for any reason during the life of the above referenced Contract, the Contractor will immediately notify the Department of Education / Division of Vocational Rehabilitation in writing.
| STATE OF FLORIDA |
| NAME OF CONTRACTOR ENTITY | COUNTY OF | ||
Sworn to and subscribed
| before me this |
| Signature of Authorized Representative | day of | , | , |
| by |
| (name of person making statement) |
| Printed Name of Authorized |
| Representative | NOTARY PUBLIC |
Personally known ____, OR
Produced Identification ___
______________________________________ Type of Identification
| Date | Produced | |
Form DBS CM10
Last Revised June 6, 2014