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Get DC Clean Hands Self Certification 2006-2024

You must complete and submit this certification form with any application for a license or permit or renewal by the Clean Hands Before Receiving a License or Permit Act of 1996 effective May 11 1996 DC Law 11-118 DC Code Sec. 47-2861 et seq. 01 et. seq. 2001 ed. or Past Due Taxes owed to the Office of Tax and Revenue pursuant to Title 47 of the DC Code or Past due District of Columbia Water and Sewer Authority service fees pursuant to Title 34 Chapter 22 and 24 of the DC Code 2001 ed. or ed. I understand that a signed and dated Clean Hands Self Certification Form is required as documentation to accompany my application for a business license license endorsements and permits. Print Form Basic Business License Clean Hands Form LICENSE DIVISION CLEAN HANDS SELF CERTIFICATION TO THE APPLICANT Please read this form carefully and completely before signing. The District government shall not issue or reissue any license or permit if the applicant owes it more than 100 in outstanding debt. as amended effective October 21 2000 DC Law 13-183 sec* 2 b DC Code sec* 47-2861 et. seq. I as certify that name owner/partner/corporate officer business name trading as at using business tax number trade name business address FEIN/SSN as of this date does not owe more than one hundred dollars 100 in outstanding debt to the District of Columbia government as a result of Fines penalties or interest assessed pursuant to the Litter Control Administration Act of 1985 effective March 25 1986 DC Law 6-100 DC Code Sec* 8-801 et. seq. 2001 ed* or 1994 DC Law 10-117 DC Code Sec* 8-901 et. seq. 2001 ed* or Infraction Act of 1985 effective October 5 1985 DC Law 6-42 DC Code Sec* 2-1801. I understand completing and submitting this form does not guarantee that my license or permit will be approved* Hands Self Certification Form* immediately to revoke each license or permit for which I am applying and fine me one thousand dollars 1 000. Signature and Title Date For help with this form please call 202 442-4400. Department of Consumer Regulatory Affairs 1100 4th Street SW Washington DC 20024 Phone 202 442-4400 Fax 202 442-4523 For Relay Service call 711 Email bbl*infocenter dc*gov 12-01-06. Print Form Basic Business License Clean Hands Form LICENSE DIVISION CLEAN HANDS SELF CERTIFICATION TO THE APPLICANT Please read this form carefully and completely before signing. The District government shall not issue or reissue any license or permit if the applicant owes it more than 100 in outstanding debt. as amended effective October 21 2000 DC Law 13-183 sec* 2 b DC Code sec* 47-2861 et. seq. I as certify that name owner/partner/corporate officer business name trading as at using business tax number trade name business address FEIN/SSN as of this date does not owe more than one hundred dollars 100 in outstanding debt to the District of Columbia government as a result of Fines penalties or interest assessed pursuant to the Litter Control Administration Act of 1985 effective March 25 1986 DC Law 6-100 DC Code Sec* 8-801 et. seq. 2001 ed* or 1994 DC Law 10-117 DC Code Sec* 8-901 et. seq. 2001 ed* or Infraction Act of 1985 effective October 5 1985 DC Law 6-42 DC Code Sec* 2-1801. .

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