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 LANTNAVFACENGCOM A&E GUIDE
4/17/93
INSTRUCTIONS FOR COMPLETING AFFIDAVIT
LANTDIV NORVA 4-4235/4 (Rev. 5/81)
(See Sample - Page 1-17)
(1) A&E Contract Number
(2) Invoice Number
(3) State and County Located
(4) Name and Title of Company Official Signing Affidavit
(5) Name of A&E Firm
(6) A&E Contract Number
(7) Period Ending for Work Performed
(8) Original Signature of Company Official
(9) Date Signed and Notarized
(10) Notary's Signature (Notary Stamp or Raised Seal is Required for
Out-of-State Firms)
AN AFFIDAVIT IS NOT REQUIRED FOR OVERSEAS FIRMS
1-16
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