Attestation of Financial Statement Professional Employer Organization Group (less than one hundred fifty thousand dollars) PEO-5

Attestation of Financial Statement for a Professional Employer Organization or Professional Employer Organization Group

(with less than one hundred fifty thousand dollars in working capital at renewal) PEO-5
I, the undersigned, do hereby attest to the accuracy and completeness of the quarterly financial statements submitted herein, and attached hereto by PEO Applicant as part of the application process for licensure as a Professional Employer Organization.

I attest that the financial statement is prepared pursuant to generally accepted accounting principles by an independent certified public accountant licensed to do business in the state and that this is the applicant's most recent financial statement.

I attest that all wages, taxes, workers' compensation premiums and employee benefits have been paid by the professional employer organization or members of the professional employer organization group and that the applicant is not delinquent in the payment of state or federal taxes.
Date:

MonthDayYear
Signature of Chief Financial Officer:
Printed name of Chief Financial Officer:

First NameLast Name
Should be Empty:

Attestation of Financial Statement for a Professional Employer Organization or Professional Employer Organization Group