Page 99 - IRS Business Tax Credits Guide

12:51 - 5-Jan-2023
Page 20 of 38
Fileid: … ns/i8933/202212/a/xml/cycle06/source
The type and rule above prints on all proofs including departmental reproduction proofs. MUST be removed before printing.
Page 7
Capture Facility Certification (continued)
Under penalties of perjury, I attest that I am an officer of the company that’s the owner of the subject capture facility. I further attest that the above
information is true and correct.

Signature and date signed

Printed or typed name of person signing this report

Title

Company's name and EIN

Model Certificate CF

-20- Instructions for Form 8933 (Rev. 12-2022)