CLAIMANT'S CERTIFICATION AND DECLARATION
I do solemnly declare and certify under the penalty of the law that the within bill is correct in all its particulars, that no bonus has been given or received by any person or persons within the knowledge of this claimant in connection with the above claim and that the amount charged is a reasonable one.

This form has been approved by the Local Finance Board as an approved voucher form. Attach your voucher as signature of claimant.

Paul M. Lesniak
Paul M. Lesniak, CTC/CMFO
President, TCTANJ