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199 A SAFE HARBOR


Marie

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I couldn't find it in ATX, so I guess you would have to add it as a blank statement.

The statement is simply that the requirements in Section 3.03 of Notice 2019-07 have been satisfied.

The statement must be signed by the taxpayer, or an authorized representative of an eligible taxpayer or Relevant Passthrough Entity, which states:

Under penalties of perjury, I (we) declare that I (we) have examined the statement, and, to the best of my (our) knowledge and belief, the statement contains all relevant facts relating to the revenue procedure, and such facts are true, correct, and complete.

The individual or individuals who sign must have personal knowledge of the facts and circumstances related to the statement.

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