Sworn Statement of Income: SUBSCRIBED AND SWORN TO Before Me This - Day of - , 2013
Sworn Statement of Income: SUBSCRIBED AND SWORN TO Before Me This - Day of - , 2013
Sworn Statement of Income: SUBSCRIBED AND SWORN TO Before Me This - Day of - , 2013
I am _________________________________________________________________, residing at
(indicate full name, middle name and surname)
____________________________________________________________.
(indicate complete address)
principal source of subsistence and livelihood and my gross sales/receipts in a 12-month period does not
___________________________________
Taxpayer
(Signature over Printed Name)
__________________
Date
___________________________________
Witness attesting to identity of taxpayer
(Signature over Printed Name)
(i.e. Barangay Chairman)
___________________________________
BIR Revenue Officer
(Signature over Printed Name)
Note: This form should be translated in local dialect if necessary to make taxpayer-registrant properly understand the content of this
declaration.