Affidavit of Minority Status
state of louisiana
parish of ___________________:
before me, the undersigned authority, personally came and appeared _________________________________, who stated, under oath, that s/he is a citizen or lawful permanent resident of the United States and is of minority heritage as defined at R.S. 39:1952(12).
_________________________
affiant
sworn to and subscribed before me this ____ day of ____________, 20__, at ___________________, Louisiana.
_________________
notary
Affidavit of Recertification
state of louisiana
parish of ___________________:
before me, the undersigned authority, personally came and appeared ________________________, who stated, under oath, that s/he is owner of a certified minority-owned business as provided at Chapter 19 of Subtitle III, of Title 39 of the Louisiana Revised Statutes as of the ____ day of ___________, 20____, and that s/he appears herein for the purposes of attesting to the fact that all information contained in the original certification is still true and correct, and that s/he remains the owner of the minority-owned business, ___________________________, as appears in
(Name of Business)
the files of the Office for Minority Business Enterprise.
____________________
affiant
sworn to and subscribed before me this ____ day of ____________, 20__, at ___________________, Louisiana.
______________________
NOTARY
La. Admin. Code tit. 19, § III-1701