1. (a) The person(s) requesting the waiver shall authorize an individual to sign and date the request.
2. (b) The authorized individual shall sign and date the request and print or type their name and title by the signature.

3. (c) The signature shall constitute certification that:

   1. (1) The information provided is true, complete, and not misleading to the knowledge and belief of the signer; and

   2. (2) The signer understands that:

      1. a. The submission of false, incomplete, or misleading information is grounds for denying the waiver request or revoking any waiver that is granted based on the information; and
      2. b. The signer is subject to the penalties specified in New Hampshire law, RSA 641:3, for making unsworn false statements.

Source. #10831, eff 6-1-15; ss by #14419, eff 11-4-25, EXPIRES: 11-4-35