5 CFR Appendix A to Part 2634, Certificate of Independence (Form Approved: OMB Control No. 3209-0007)

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Appendix A to Part 2634 - Certificate of Independence (Form Approved: OMB Control No. 3209-0007)

The Certificate of Independence required by § 2634.405(d)(2) shall be executed as follows:

Certificate of Independence

With respect to the trust of ____ (Settlor), which has been submitted to the Office of Government Ethics for certification pursuant to the Ethics in Government Act of 1978 (Pub. L. 95-521, as amended), the undersigned proposed [Trustee] [____] of such trust is a financial institution which is eligible to serve in such fiduciary capacity in accordance with section 102(f)(3)(A) of such Act:

FIRST: The undersigned is (check one) -

( ) a bank, as defined in 12 U.S.C. 1841(c), or

( ) an investment adviser, as defined in 15 U.S.C. 80b-2(a)(11), not more than 10 percent of which is owned or controlled by a single individual.

SECOND: The undersigned -

(1) Is independent of and unassociated with any interested party so that the undersigned cannot be controlled or influenced in the administration of the trust by any interested party; and

(2) is not and has not been affiliated with any interested party, and is not a partner of, or involved in any joint venture or other investment or business with any interested party.

THIRD: Any director, officer, or employee of the undersigned -

(1) Is independent of and unassociated with any interested party so that such director, officer, or employee cannot be controlled or influenced in the administration of the trust by any interested party;

(2) Is not and has not been employed by any interested party, nor a director, officer, or employee of any organization affiliated with any interested party, and is not and has not been a partner of, or involved in any joint venture or other investment or business with, any interested party; and

(3) Is not a relative of any interested party.

FOURTH: The undersigned certifies that the statements contained herein are true, complete and correct to the best of such undersigned's knowledge and belief.

Date___

(firm)___

By:___

(title)___

Note:

See Appendix C of this part for Privacy Act and Paperwork Reduction Act notices.

[ 57 FR 11829, Apr. 7, 1992, as amended at 63 FR 58620, Nov. 2, 1998; 77 FR 39150, July 2, 2012]

This is a list of United States Code sections, Statutes at Large, Public Laws, and Presidential Documents, which provide rulemaking authority for this CFR Part.

This list is taken from the Parallel Table of Authorities and Rules provided by GPO [Government Printing Office].

It is not guaranteed to be accurate or up-to-date, though we do refresh the database weekly. More limitations on accuracy are described at the GPO site.


United States Code
U.S. Code: Title 5 - APPENDIX
U.S. Code: Title 26 - INTERNAL REVENUE CODE
U.S. Code: Title 28 - JUDICIARY AND JUDICIAL PROCEDURE
Statutes at Large
Presidential Documents

Executive Order ... 12674

Executive Order ... 12731

Title 5 published on 2015-12-02

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 5 CFR Part 2634 after this date.

  • 2017-01-24; vol. 82 # 14 - Tuesday, January 24, 2017
    1. 82 FR 8131 - Civil Monetary Penalties Inflation Adjustments for Ethics in Government Act Violations
      GPO FDSys XML | Text
      OFFICE OF GOVERNMENT ETHICS
      Final rule.
      Effective date: This final rule is effective January 24, 2017. Applicability date: This final rule is applicable January 15, 2017.
      5 CFR Parts 2634 and 2636

Title 5 published on 2015-12-02.

The following are only the Rules published in the Federal Register after the published date of Title 5.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2017-01-24; vol. 82 # 14 - Tuesday, January 24, 2017
    1. 82 FR 8131 - Civil Monetary Penalties Inflation Adjustments for Ethics in Government Act Violations
      GPO FDSys: XML | Text
      OFFICE OF GOVERNMENT ETHICS
      Final rule.
      Effective date: This final rule is effective January 24, 2017. Applicability date: This final rule is applicable January 15, 2017.
      5 CFR Parts 2634 and 2636