§290.APPENDIX D. Professional or Artistic Services Affidavit

Submitting Agency:

 

Division:

 

Address:

 

Vendor:

 

Address:

 

Contract:

 

)

State of Illinois                        )          SS

County of                                )

)

 

I ______________________, being duly sworn, solemnly (swear) (affirm) that:  I am (give official title and office of affiant).  The professional or artistic services specified in the attached contract were agreed to by this agency and the vendor prior to commencement of the services and the contract was not reduced to writing before the services commended because:  

 

The attached contract was not filed within 30 days of execution because:

 

I am duly authorized to make this affidavit.  This affidavit is made pursuant to and in fulfillment of the requirements of Section 15 of the State Comptroller Act.  I know and understand the contents of this affidavit, and all statements herein are true and correct.

 

		Signature of Affiant
Subscribed and sworn before me this			day of		, 19		.

 

(Seal)
	Notary Public
	My Commission Expires:

 

(Source:  Added at 7 Ill. Reg. 5419, effective April 13, 1983)