Professional Documents
Culture Documents
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The undersigned b ~ , oflegal age, -7'''-'''--'F.=-----;
stalus), and resident of,~ i ; , hereby declare
follows:
1. That my personal circumstances are as above stated.
2. That I have never been convicted under any federal, state, foreign or Puerto Rico laws
in connection with any of the crimes listed in Act No. 458 of December 29,2000, as amended by
Act No. 428 of September 22, 2004, or the equivalent crimes in the applicable jurisdiction, which
crimes involve fraud, embezzlement or illegal appropriation of public funds, nor has any ofthe
abovementioned pled guilty for the comruission of any such crimes, including but not limited to
the following:
a. Aggravated illegal appropriation of goods in all its modalities;
b. Extortion;
c. Fraud in the execution of construction projects;
. Fraud in the delivery of goods;
e. Undue intervention in procurement processes or awarding of bid contracts or in
government operations;
f. Bribery in any of its modalities;
g. Aggravated bribery;
h. Offer to bribe;
i. Undue influence;
j. Crimes against public funds;
k. Preparation of false documents;
1. Presentation of false documents;
m. Falsification of documents;
n. Possession or delivery of false documents;
3. That I am not under investigation under any federal, state, foreign or Puerto Rico laws,
nor by any legislative, judicial or administrative entity in any ofthese jurisdictions for the alleged
commission of the abovementioned crimes.
4/3 Affidavit No.
4. The above stated is true to the best of my knowledge and belief and is submitted in
compliance with Act No. 458 of December 29, 2000, as amended by 428 of September 22, 2004
with all the legal effects it carnes.
n ~ { teditw,thiS
2012. - . ~
~ ~
Appendix C
SWORN STATEMENT
The to ') s (ZA I.'>lof legal age, \iIAOVV"e J (marital
status), and resident , declare under oath as
follows:
1. That my personal circumstances are as above stated,
2. That 1have never been convicted under any federal, state, foreign or Puerto Rico
laws in connection with any of the crimes listed in Act No. 458 of December 29, 2000, as
amended by Act No. 428 of September 22, 2004, or the equivalent crimes in the applicable
jurisdiction, which crimes involve fraud, embezzlement or illegal appropriation of public funds,
nor has any of the abovementioned pled guilty for the commission of any such crimes, including
but not limited to the following:
a. Aggravated illegal appropriation of goods in all its modalities;
b. Extortion;
c. Fraud in the execution of construction projects;
d. Fraud in the delivery of goods;
e. Undue intervention in procurement processes or awarding of bid contracts
or in government operations;
f. Bribery in any of its modalities;
g. Aggravated bribery;
h. Offer to bribe;
i. Undue influence;
j. Crimes against public funds;
k. Preparation of false documents;
I. Presentation of false documents;
m, Falsification of documents;
n. Possession or delivery of false documents;
App. Col
3. That I am not under investigation under any federal, state, foreign or Puerto Rico
laws, nor by any legislative, judicial or administrative entity in any of these jurisdictions for the
alleged commission of the abovementioned crimes.
4. The above stated is true to the best of my knowledge and belief and is submitted
in compliance with Act No. 458 of December 29, 2000, as amended by 428 of September 22,
2004 with all the leAl effects it carries.
InStil)
2l
('-
)
Affidavit No. GlL.-
,9ircun;jstances, w
"'CIA 'J4f iI\ ,
App. C-2
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Notary Public,