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Form W-7 California San Bernardino: What You Should Know

By signing this form: • I understand and certify, under penalty of perjury, that all my answers on this report are correct and complete to the best of my. • I understand and certify, under penalty of perjury, that this information in the Report is true and correct and that I have not made any material, false, frivolous, or misleading statement or omission on the report. COPY THIS CERTIFICATION OF COMPLETION OF STATEMENT OF USE OF INFORMATION TO BE USEFUL FOR PROGRAM ISSUES BY FEDERAL, STATE OR LOCAL GOVERNMENT OFFICIALS and MARK THIS FORM WITH A SIGN THAT I HAVE COMPLETED THE REPORT  If any of the statements to the Report are untrue, erroneous, or misleading I am liable to civil or criminal penalties, forfeiture of the benefit paid or provided as authorized by the Social Security Act, and civil and criminal fines, or both, in the amount determined by the judge or jury in the case.

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