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Legal Statement of Information

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LEGAL STATEMENT OF INFORMATION

This Legal Statement of Information (the "Statement") is made as of Date: by and between Declarant Name: (Entity Type: ), with principal address: ; and Recipient Name: (Entity Type: ), with principal address: .

RECITALS

WHEREAS, Declarant possesses certain factual, financial, organizational, or operational information described herein and intends to provide that information to Recipient for the purposes set forth in this Statement;

WHEREAS, Recipient requires such information to evaluate, document, or otherwise act with respect to a proposed transaction, relationship, or lawful purpose identified in this Statement;

WHEREAS, the parties desire to set forth the terms under which Declarant shall provide information to Recipient and the rights, limitations, and remedies applicable to use and reliance on that information.

NOW, THEREFORE

In consideration of the mutual covenants and agreements contained in this Statement and for other good and valuable consideration, the receipt and sufficiency of which are acknowledged, the parties agree as follows:

1. DEFINITIONS

1.1 "Information" means all written, electronic, and oral data, documents, records, disclosures, and other materials provided by Declarant to Recipient pursuant to this Statement, including any summaries, analyses, or extracts thereof.

1.2 "Permitted Purpose" means the specific business or legal purpose identified by the parties in connection with which the Information is provided, as described in Section 2.1 below.

2. STATEMENT AND CERTIFICATION

2.1 Declarant shall provide to Recipient a written summary of the Information and any supporting documents identified under Summary of Information:

2.2 Declarant expressly certifies, to the best of Declarant's knowledge after reasonable inquiry, that the Information provided as of the date hereof is true, accurate, and complete in all material respects, and that no material fact has been omitted that would render the Information misleading.

3. USE, DISCLOSURE AND LIMITATIONS

3.1 Recipient shall use the Information only for the Permitted Purpose and shall not disclose, publish, or distribute the Information to third parties except: (a) to Recipient's directors, officers, employees, agents, advisors, or financing sources who have a need to know and are bound to maintain confidentiality substantially similar to this Statement; or (b) as required by law, regulation, or a valid order of a court or governmental authority.

3.2 Recipient shall exercise at least the same degree of care in protecting the Information as it uses to protect its own confidential information of like importance, but in no event less than a reasonable degree of care.

4. ACCURACY; UPDATES; RELIANCE

4.1 Declarant agrees to notify Recipient promptly in writing of any material inaccuracy or change in the Information that becomes known to Declarant after delivery of such Information.

4.2 Recipient acknowledges that Recipient's use of the Information is at Recipient's sole risk. Except as expressly provided in Section 2.2, Declarant makes no representation or warranty, express or implied, as to the accuracy or completeness of the Information and disclaims all other warranties, including merchantability and fitness for a particular purpose.

5. REPRESENTATIONS AND WARRANTIES

5.1 Each party represents and warrants that it has the authority to enter into this Statement and to perform its obligations hereunder. Declarant further represents that, to Declarant's knowledge, the Information does not infringe upon the intellectual property rights of any third party.

6. INDEMNIFICATION; LIMITATION OF LIABILITY

6.1 Declarant shall indemnify and hold harmless Recipient, its affiliates and their respective officers, directors, employees and agents from and against any losses, liabilities, damages, costs and expenses (including reasonable attorneys' fees) arising out of a breach of the certifications set forth in Section 2.2.

6.2 Except for liability arising from a party's willful misconduct or material breach of Section 2.2, in no event shall either party be liable to the other for consequential, incidental, special or punitive damages, and aggregate liability shall be limited to direct damages not to exceed the direct costs incurred by the aggrieved party in connection with the Permitted Purpose.

7. RECORDS, RETENTION AND RETURN

7.1 Recipient shall maintain complete and accurate records of the Information in its possession and shall, upon written request by Declarant, return or destroy the Information and certify in writing the completion of such return or destruction, except to the extent retention is required by applicable law or a bona fide internal policy.

8. NOTICES

All notices required or permitted under this Statement shall be in writing and delivered to the parties at the addresses set forth below (or to such other address as a party may designate by notice):

9. MISCELLANEOUS

Governing Law: This Statement shall be governed by and construed in accordance with the laws of the jurisdiction selected by the parties below without regard to its conflicts of law principles. Jurisdiction selection:

Entire Agreement: This Statement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior oral or written representations, understandings and agreements. No representation or promise not expressly set forth in this Statement shall be binding.

Severability: If any provision of this Statement is held to be invalid, illegal, or unenforceable by a court of competent jurisdiction, the remaining provisions shall remain in full force and effect and the invalid provision shall be reformed to the extent necessary to make it enforceable while preserving the parties' intent.

Amendments; Waiver: This Statement may be amended only by a written instrument signed by both parties. No failure or delay by either party in exercising any right shall operate as a waiver, nor shall any single or partial exercise of any right preclude further exercise of that right.

Counterparts: This Statement may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument. Electronic or facsimile signatures shall be effective as originals.

ATTACHMENTS AND DOCUMENTS

Declarant

Party Label:

By:

Date:

Recipient

Party Label:

By:

Date:

Enter text✕

What the Legal Statement of Information Is and When it Applies

A Legal Statement of Information is a concise written declaration used to record factual details, identities, or conditions for a legal purpose. Typical uses include business filings, corporate agent disclosures, sworn factual recitations, and attachments to contracts or regulatory submissions. The document establishes an auditable record of facts, parties, and effective dates that may be required by government agencies, counterparties, or courts.

Why a Clear Legal Statement of Information Matters

A properly completed statement reduces ambiguity about parties, dates, and material facts, strengthens enforceability under electronic-signature law, and helps satisfy administrative or regulatory filing requirements in the United States.

Why a Clear Legal Statement of Information Matters

Stepwise Completion: Filling and Finalizing the Statement

Complete the form in the order below to reduce errors and preserve a clear audit trail for reviewers and regulators.

  • 01
    Gather documents: Collect IDs, formation records, and supporting exhibits before starting.
  • 02
    Enter core data: Populate names, addresses, entity type, and effective date first.
  • 03
    Attach evidence: Upload supporting documents and reference them in the facts section.
  • 04
    Sign and retain: Sign with required authentication and save a final PDF with audit trail.

Who Typically Prepares and Signs This Statement

Choose the signer with authority to bind the named party; when in doubt, include a title line and attach a corporate resolution or power of attorney.

  • Corporate officers, registered agents, and company secretaries preparing state filings or disclosures
  • Legal counsel and paralegals assembling factual recitals for agreements or court exhibits
  • HR or benefits administrators certifying employment or eligibility facts on behalf of an employer

Common Signers and Their Authority

Brian Fitzgibbons, COO

A corporate officer such as a COO typically has authority to sign operational declarations and internal statements for the company when authorized by the board or corporate bylaws; include a reference to the authorizing resolution when filing with regulators.

Kodi-Marie Evans, Director

A director or authorized signatory may execute statements affecting corporate status or disclosures; the document should state the signer’s capacity and attach any written delegation of authority.

Core Elements to Include in a Professional Statement of Information

A robust statement combines identity details, a clear factual narrative, date and signature mechanics, and references to corroborating documents; these items together support reliability and legal utility.

Title and Purpose

Start with a clear heading that states the document type and purpose, for example 'Legal Statement of Information — Corporate Agent Disclosure,' so reviewers understand context immediately and indexing is consistent.

Parties and Capacity

List each party with exact legal names and specify the signer’s role or capacity (e.g., 'Jane Doe, Manager, Acme LLC') to show authority to act and to avoid later signature disputes.

Effective Date

Include the effective date in MM/DD/YYYY format and, where relevant, a separate execution date for each signer to reflect multi-party timelines or staggered deliveries.

Factual Narrative

Provide a concise, numbered statement of facts with specific dates, contract references, or exhibit identifiers so external reviewers can verify assertions quickly.

Supporting Exhibits

Attach or reference documents that corroborate facts—formation certificates, contracts, ID copies—and label exhibits clearly within the statement for auditability.

Signature and Authentication

Include printed name, title, signature, date, and any notarization or witness lines required by jurisdiction or filing authority to ensure procedural validity.

Critical Information Fields to Capture

Legal name: Exact as ID
Entity type: Corporation, LLC, etc.
Address: Street, city, ST ZIP
Effective date: MM/DD/YYYY
Signer capacity: Title or role
Document refs: Exhibit numbers

Configure an Online Workflow for Electronic Completion

Set up a repeatable workflow that places fields, authentication, and signing order to maintain compliance and a clear audit trail.

Field Configuration
Name field Required, default to signer name
Date field Auto-fill or require MM/DD/YYYY
Signer order Define sequential or parallel routing
Authentication Email + optional SMS or KBA

Technical Options for Digital Signing and Submission

Ensure the platform preserves timestamps and provides an auditable certificate of completion to support legal admissibility and regulatory review.

  • File formats: PDF and DOCX are standard
  • Authentication: Email, SMS, KBA, or SSO
  • Integrations: CRM and cloud storage

Where to File, Send, or Submit the Completed Statement

Routing depends on the document’s purpose: state filing, counterparty, regulator, or internal record; follow the recipient’s prescribed method for the fastest acceptance.

  • State agency: Submit to the Secretary of State or specific filing office when required by statute.
  • Counterparty: Deliver to the contract counterparty in the agreed method stated in the contract.
  • Regulatory body: Send filings to the named regulator using their accepted electronic or paper channels.
  • Internal records: Store a signed PDF in your records management system with retention metadata.

Timing Considerations and Common Deadlines

Track filing and tax deadlines that may be affected by the statement’s effective date or the date of signature to avoid late-filing penalties.

Provide on request:

W-9-style documents should be returned upon payer request; no fixed statutory date

Tax reporting:

Information affecting 1099/W-2 must adhere to Jan 31 recipient deadlines when relevant

Corporate filings:

State-specific filing windows or annual reports may require updated statements

Notarization timing:

Complete notarization during signing or per notary session rules

Record retention:

Keep final signed copy according to applicable retention rules

Common Preparation Errors to Avoid

  • Using trade names instead of the full legal entity name leads to rejection or need for correction requests.
  • Incorrect or inconsistent dates (effective versus signing date) cause disputes over when obligations began or deadlines were triggered.
  • Missing signer capacity lines or failing to attach proof of authority (resolution or POA) can invalidate the filing for official purposes.
  • Uploading low-quality supporting documents or mislabeling exhibits complicates verification and slows administrative acceptance.

Penalties and Legal Risks of Incorrect Statements

Tax penalties: IRC §6721 fines for incorrect returns
I-9 risks: 8 CFR §274a.2 paperwork fines
Contract disputes: Challenge to enforceability
Regulatory rejection: Filing returned for correction
Notarization defects: Delay or invalid acknowledgment
Fraud exposure: Intentional misstatement penalties

eSignature Pricing and Feature Comparison for Completing Legal Statements

Basic price and feature differences can affect per-document costs and compliance options; signNow is listed first for direct comparison.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial Varies by plan Varies by plan Varies by plan Varies by plan
Bulk Send Yes (select plans) Yes Yes Yes Yes
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes (BAA available) Yes (BAA available) Yes Varies Varies

Real-World Examples of How the Statement Is Used

Short examples illustrate practical use across organizations and common outcomes when the form is completed correctly.

Optica Ventures — Operations

The COO prepared a concise agent disclosure to update state filings

  • The filing referenced the corporate resolution authorizing the officer
  • The clear statement and attached exhibits avoided follow-up questions and allowed the Secretary of State acceptance without amendment.

Fertility Centers — Healthcare

A director submitted a statement containing limited patient-authorized data with a signed HIPAA addendum

  • The transmission used a HIPAA-compliant eSignature workflow
  • The provider retained the audit trail and authorization for the required six-year HIPAA retention period.

Frequently Asked Questions and Troubleshooting

Questions below address common completion, signature, and filing issues encountered with Legal Statements of Information.


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