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Certificate of Clean Hands (formerly Certificate of Good Standing)
Government of the District of Columbia
Office of the Chief Financial Officer
Office of Tax and Revenue
I am hereby requesting a Clean Hands Certificate for the following entity:
Entity name
*
Address
*
Telephone number
*
Email
*
FEIN/SSN
*
Requestor
*
Title
*
Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2011
2012
2013
2014
2015
Attach
If this is a third-party request, please submit a Power of Attorney with this request form. Should you have additional questions, please contact Rhonda Lycorish at (202) 442-6815 or via email Rhonda.Lycorish@dc.gov.
How would you like to receive your certification?
*
Pick-Up (Office of Tax and Revenue, 1101 4th Street, SW, Suite 270, Washington DC 20024)
Mail
How many copies of the certificate are being requested?
*
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