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COUNTERTERRORISM
COMPLIANCE
In compliance with the spirit and intent of the USA
PATRIOT Act and other counterterrorism laws, the United
Way of Aroostook requests that each funded agency
(organization) certify that it is incompliance with
the United Way of Aroostook and the United Way of
America’s (UWA) compliance program.
Organization
Name: ______________________________________________________________
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the Appropriate Box to Indicate Your Compliance
With Each of the Following: |
Comply |
Do
Not
Comply |
This
Organization is not on any federal terrorism
“watch lists,” including the list
in Executive Order 13224, the master list of
specially designated nationals and blocked persons
maintained by the Treasury Department, and the
list of Foreign Terrorist Organizations maintained
by the State Department.
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This
Organization does not, will not and has not
knowingly provided financial, technical, in-kind
or other material support or resources* to any
individual or entity that is a terrorist or
terrorist organization, or that supports or
funds terrorism.
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This
Organization does not, will not and has not
knowingly provided or collected funds or provided
material support or resources with the intention
that such funds or material support or resources
be used to carry out acts of terrorism.
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This
Organization does not, will not and has not
knowingly provided financial or material support
or resources to any entity that has knowingly
concealed the source of funds used to carry
out terrorism or to support Foreign Terrorist
Organizations.
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This
Organization does not regrant to organizations,
individuals, programs and/or projects outside
of the United States of America with out compliance
with IRS guidelines.
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This
Organization takes reasonable, affirmative steps
to ensure that any funds or resources distributed
or processed do not fund terrorism or terrorist
organizations.
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This
Organization takes reasonable steps to certify
against fraud with respect to the provision
of financial, technical, in-kind or other material
support or resources to terrorists and terrorist
organizations.
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* In
this form, “material support and resources”
means currency or monetary instruments or financial
securities, financial services, lodging, training,
expert advice or assistance, safehouses, false
documentation or identification, communications
equipment, facilities, weapons, lethal substances,
explosives, personnel, transportation, and other
physical assets, except medicine or religious
materials.
I certify on behalf of the Organization listed
above that the foregoing is true.
Print
Name: _______________________________________
Signature: _________________________________________
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Title:
_________________________________
Date: _________________________________
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©
2004 -2007 United Way of Aroostook, All rights reserved.
480 Main St, 3rd Floor Presque Isle, Maine, 04769
Phone: 207.764.5197 Fax: 207.764.8566 Email: acunited@mfx.net
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