E-CERT1
10/07
CERTIFICATION OF COMPLIANCE WITH FEDERAL AND STATE LAW RESPECTING THE REPORTING OF
COMPENSATION FOR CERTAIN EMPLOYEES
I, _________________________ school business administrator, or designee, of the Board of Education of
______________________, do make this certification pursuant to the provisions of N.J.S.A. 18A:17-14.4 (P.L.
2007, c. 53).
1.
For the calendar year ending December 31, 20
___,
the following named individuals were employed by the
Board of Education of _______________ in the identified positions:
A.
__________________________, _____________________, as superintendent of schools;
(Print Name) (Social Security Number)
B.
__________________________, _____________________, as assistant
superintendent of schools;
(Print Name) (Social Security Number)
C. __________________________, _____________________, as school business administrator;
(Print Name) (Social Security Number)
2.
In the preparation and submission of federal and State of New Jersey in
come tax related documentation for
the
referenced individuals, the Board of Educ
ation of _________________ complied fully with federal and
state law requirements respecting the types of compensation required to be reported for
income
tax
purposes. For purposes of this
certification, “income tax related docum
entation” includes tax forms W2’s,
W3’s, 1099’s, 927’s, 941’s, and such other reporting forms as may be required from time to
time
pursuant
to state and/or federal income tax law.
I certify that the foregoing statements made by me are true to the best of my knowledge, information, and belief. I
understand that if any of the foregoing statements are willfully false, I am subject to punishment.
___________________________________________________
(Print
Name) School Business Administrator (or designee)
Board of Education of _________________________________
___________________________________________________
Signature(s)
Dated: _______________
