"I certify under the penalty of perjury that to the best of my knowledge and belief the statements made and information given herein are true. I further certify that this submission is in compliance with M.G.L. c. 21J and 503 CMR 2.00. I hereby consent to all audits of payment and necessary inspections made to verify the accuracy of any submission to the Board or DOR and made pursuant to law and incidental to the issuance of licenses, registrations, permits, certificates and the operation of an UST System. I am aware that there are significant penalties for submitting false information, including possible fines, civil penalties and imprisonment. I further certify that I am authorized to execute this form.
I agree to return any erroneous payment to the Fund within ten days of either the receipt of the erroneous payment or the receipt of a written notice from the Board or DOR that an erroneous payment was made."
503 CMR, § 2.03