Under penalty of perjury statement example 2026

1. Click ‘Get Form’ to open the under penalty of perjury statement example in the editor.
2. Begin by filling in the state and county where you reside at the top of the form. This establishes your jurisdiction.
3. Enter your name as the account holder, followed by the financial institution's name that issued the ACH debit notification.
4. Provide your account number and the date of the unauthorized or improper transaction, along with the amount charged.
5. Complete either Section 1 or Section 2 based on whether you are disputing an unauthorized consumer entry or an improper entry. Check the appropriate boxes and fill in any required details.
6. Sign and date the form at the bottom, certifying that all information provided is true and correct under penalty of perjury.

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