Can this be signed electronically?

Yes, if the electronic signature meets ESIGN and UETA tests: intent, consent, attribution, and record retention. For consumer-facing matters, provide required ESIGN consumer disclosures.

Is notarization always required?

Not always. Requirement depends on recipient and state law. If a notary or witnesses are requested by the receiving authority, follow the specific jurisdictional rules or use RON where accepted.

What if the name does not match records?

Correct the name to match legal or corporate records or attach a certified explanation. Mismatched names can invalidate the declaration for official purposes.

How long should I retain the signed copy?

Retain per the longest applicable rule: IRS three-year baseline, HIPAA six years, and sector-specific statutes. When in doubt, keep records for seven years and consult counsel.

Can an agent sign on behalf of a company?

Yes, with written authorization such as a power of attorney or corporate resolution. Attach proof of authority and ensure the eSignature workflow records the agent's identity.

What happens after submission?

The recipient may accept the declaration, request supporting documents, or require an amended filing. Keep communication records and track any follow-up deadlines.

Electronic Signature
Templates
Miscellaneous
Miscellaneous Declaration of Non-Filling

Miscellaneous Declaration of Non-Filling

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

MISCELLANEOUS DECLARATION OF NON-FILLING

This Miscellaneous Declaration of Non-Filling (the "Declaration") is made as of by and between Declarant: and Recipient: .

WHEREAS

WHEREAS, Declarant has been engaged to provide certain services and perform tasks described herein to Recipient pursuant to mutual understandings; and Declarant's business address is .

WHEREAS, for purposes of Recipient's internal records, regulatory compliance, or third-party reporting, Recipient requires a written certification from Declarant that certain filings, submissions, registrations, or similar formal filings have not been made by Declarant in respect of the subject matter described below during the relevant period.

WHEREAS, the parties desire to set forth their agreement and Declarant's representations concerning non-filing and to address ancillary commercial terms, confidentiality, and governing law.

SCOPE OF WORK

Scope of Work / Services (describe tasks, deliverables, and relationship to declaration)

DECLARATION OF NON-FILLING

Declarant hereby certifies, represents and warrants to Recipient as follows:

Declarant has not filed, submitted, registered, recorded, delivered, or otherwise caused to be made any formal filing, application, notice, claim, or return relating to: in the jurisdiction(s) of during the period commencing through .
Declarant has not authorized any third party to file or submit any such documents on Declarant's behalf, nor has Declarant received any notice that such a filing has been made by another person or entity purporting to act for Declarant.
If Declarant becomes aware of any filing or submission described above during the term of this Declaration, Declarant will notify Recipient in writing within days and provide full particulars.

PAYMENT TERMS

Total Amount Payable Payment Schedule / Milestones Late Payment Fee

TERM AND TERMINATION

This Declaration shall commence on and shall continue until , unless earlier terminated in accordance with this section.

Either party may terminate this Declaration for convenience upon written notice to the other party given at least days prior to the effective date of termination. Either party may terminate immediately for material breach by the other party that remains uncured for more than days after written notice specifying the breach.

CONFIDENTIALITY

Each party acknowledges that in the course of performance under this Declaration it may receive or have access to confidential or proprietary information of the other party ("Confidential Information"). Confidential Information shall not include information that is (a) generally known to the public through no act or omission of the receiving party; (b) rightfully obtained by the receiving party from a third party without restriction; or (c) independently developed by the receiving party without use of Confidential Information.

The receiving party shall hold all Confidential Information in strict confidence and shall not disclose it to any third party except to its employees, agents, or professional advisors who have a need to know and who are bound by confidentiality obligations at least as protective as those herein. The receiving party shall use Confidential Information solely to exercise its rights and perform its obligations under this Declaration.

GOVERNING LAW

This Declaration shall be governed by and construed in accordance with the laws selected by the parties below, without regard to conflict of laws principles. Governing law:

ENTIRE AGREEMENT; MISCELLANEOUS

This Declaration, together with any attachments and written amendments signed by both parties, constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, proposals, or communications, whether written or oral. No amendment or waiver to any provision of this Declaration will be effective unless in writing and signed by both parties.

If any provision of this Declaration is held to be invalid or unenforceable, such provision shall be severed to the minimum extent necessary and the remaining provisions shall remain in full force and effect. The parties acknowledge that monetary damages may not be a sufficient remedy for breach of confidentiality or other provisions and that injunctive relief or specific performance may be appropriate in addition to other remedies.

REPRESENTATIONS AND WARRANTY

Declarant represents and warrants that: (a) Declarant has full authority to make the certifications and commitments set forth in this Declaration; (b) the facts and statements set forth herein are true, accurate and complete to the best of Declarant's knowledge as of the date signed; and (c) execution of this Declaration does not violate any agreement or obligation to which Declarant is a party.

NOTICES

Notice Address for Declarant Notice Address for Recipient

Declarant (Print Name):

By:

Date:

Recipient (Print Name):

By:

Date:

What the Miscellaneous Declaration of Non-Filing Is

The Miscellaneous Declaration of Non-Filing is a single-purpose sworn statement used to confirm that a party did not file a specific document, report, or claim during a stated period. It typically identifies the declarant, the matter that was not filed, the relevant timeframe, and the reason for non-filing. Agencies and counterparties use it to close administrative gaps, satisfy audit or compliance requests, or document absence of required filings. It is an evidentiary record and should be completed accurately and retained according to applicable retention rules.

Why this declaration matters for compliance and records

A clear Miscellaneous Declaration of Non-Filing reduces ambiguity for regulators and counterparties, documents intent and facts, and creates an auditable record. Properly executed, it preserves rights, prevents later disputes, and supports regulatory responses under ESIGN and state electronic-record laws.

Who typically completes or requests this declaration

Common users include corporate compliance teams, legal departments, tax preparers, healthcare administrators, and individual filers responding to agency inquiries.

Corporate compliance teams handling audit exceptions and internal controls, documenting non-filing to satisfy internal or external audit requirements.
Tax and accounting professionals responding to payer requests or IRS inquiries where a return or information filing was not required or not submitted.
Healthcare administrators and privacy officers documenting non-filing of notices or disclosures where HIPAA or state health rules apply.

Recipients include regulators, auditors, lenders, and insurers who require documented proof that a required filing was not submitted.

Who can sign and why their role matters

Corporate Officer

A duly authorized officer (CEO, CFO, corporate secretary) can sign to bind the entity. Their signature demonstrates corporate authority and may be required for formal representations in audits or regulatory submissions.

Authorized Agent

An agent with written authorization or power of attorney may execute the declaration on behalf of a person or organization. Attach or reference the authorization to avoid later questions about signer authority.

Step-by-step completion checklist

Follow these sequential steps to complete a reliable Miscellaneous Declaration of Non-Filing.

01

Prepare details: Gather IDs, corporate authorization, and the precise filing identifier.
02

Draft statement: Populate subject, dates, and reason with factual language only.
03

Confirm authority: Ensure signer has written authorization or corporate signatory power.
04

Sign and retain: Execute signature, add date, and store per retention rules.

How the declaration is processed and shared

Typical routing moves from preparer to approver to recipient; an audit trail preserves each transfer and signature event.

Upload document: Store the draft in your document system or eSignature platform.
Assign signers: Set signer order and authentication method for each party.
Sign electronically: Signer reviews and applies an e-signature meeting ESIGN/UETA tests.
Distribute copies: Send completed copies to regulators, auditors, and internal files.

Recommended digital workflow settings

Configure your eSignature workflow to preserve evidence, limit access, and automate retention.

Field	Configuration
Authentication	Email + SMS code or stronger KBA for high-risk declarations
Fields to use	Signature, printed name, title, date, optional attachment field
Conditional logic	Show additional explanation fields when 'other' is selected
Storage	Use encrypted storage with retention tagging and audit logging

Technical considerations for eSigning and storage

Choose a platform that captures an audit trail, supports required authentication, and stores signed copies securely.

Integrations: Connectors for Salesforce, NetSuite, Google Workspace, and Box
Formats: PDF and DOCX export; preserves signature metadata
Security: TLS in transit and AES-256 at rest

eSignature vendor pricing snapshot for document execution

Cross-vendor pricing and capability differences affect per-document cost and compliance options; signNow appears first for 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 trial	Varies	Varies	Varies	Varies
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	Limit 100 env/user/yr	Varies by plan	Varies by plan	Varies by plan

Essential sections every professional declaration should include

A complete declaration combines factual detail, clear identification, and attestation language to serve as an evidentiary record.

Parties

Identify declarant and any recipients using full legal names, business entity types, and contact details so future reviewers can confirm identity and authority.

Statement

A concise factual declaration describing precisely what was not filed, including form names, filing periods, and any reference numbers or matter identifiers.

Timeframe

Specify exact start and end dates for the non-filing period using MM/DD/YYYY format to anchor the statement for statute-of-limitations and audit windows.

Reason

A short factual explanation for non-filing (statutory exemption, no reportable activity, clerical error corrected) avoiding conjecture or opinions.

Attestation

Clear sworn language that the facts are true under penalty of perjury where required by statute or the requesting authority's procedures.

Acknowledgement

Signature block with printed name, title, date, and notary or witness information if jurisdiction or recipient requires formal authentication.

Common mistakes to avoid when preparing the declaration

Using informal or vague language that fails to identify the exact form or reporting obligation, causing follow-up requests or rejection.
Submitting a declaration with mismatched names, titles, or dates that prevent verification and may nullify the statement for audit purposes.
Failing to confirm signer authority or attach a power of attorney, which can lead to disputes over whether the declarant could bind the entity.
Relying on an unsigned draft or image without a proper signature method that meets ESIGN/UETA requirements for admissibility.

Potential consequences of an incorrect or incomplete declaration

Tax penalties: IRC §6721 sanctions for incorrect returns

I-9 fines: Civil penalties under 8 CFR §274a.2

Perjury risk: Criminal exposure where sworn under penalty

Contract disputes: Invalid or non-binding statements increase litigation risk

Regulatory follow-up: Agencies may demand supplemental documentation

Audit delays: Incomplete records prolong reviews and increase costs

Timing: when to prepare and submit the declaration

Prepare and submit the declaration promptly when requested by a regulator, auditor, or counterparty to avoid penalties or delays.

On request:

Provide the declaration immediately upon written or formal agency request

Audit response:

Respond within the audit deadline specified by the requesting party

Tax inquiries:

Supply supporting documentation per IRS timelines to avoid assessment

Contract deadlines:

Meet contractually agreed notice or cure periods

RON window:

Use RON workflows where accepted to meet tight submission windows

Real-world examples of how organizations used non-filing declarations

Two brief examples illustrate practical uses and the types of outcomes organizations report.

Optica Ventures — compliance response

Optica drafted a declaration to show no reportable transaction during a quarter.

It attached bank reconciliations.
The clear statement satisfied the auditor's request and closed the exception without extended inquiry, reducing administrative follow-up.

Martin Properties — transaction cleanup

Martin Properties used a declaration after discovering an intended filing had not occurred.

They documented corrective steps taken.
The declaration, combined with prompt correction, prevented escrow holdups and demonstrated good-faith action to partners.

Practical tips for accurate and defensible declarations

Apply these practices to reduce risk, speed review, and support future audits or disputes.

Use plain factual language

Avoid opinions or speculative statements. State verifiable facts and cite supporting documents where possible to reduce follow-up and strengthen the declaration's evidentiary value.

Confirm signer authority in writing

Attach a corporate resolution, power of attorney, or other written proof when an agent executes a declaration to preempt challenges to the signer's authority.

Preserve an audit trail

Capture signer authentication, IP, timestamps, and signed PDFs in a tamper-evident format. Retain metadata that proves when and how the declaration was executed.

Coordinate retention with regulators

Follow the longest applicable retention period (IRS, HIPAA, SEC) and note jurisdictional variations in an internal retention policy for easy retrieval during audits.

FAQs and troubleshooting for common execution issues

Answers to frequent questions when preparing or submitting a Miscellaneous Declaration of Non-Filing.

Need help? Contact support

Can this be signed electronically?
Yes, if the electronic signature meets ESIGN and UETA tests: intent, consent, attribution, and record retention. For consumer-facing matters, provide required ESIGN consumer disclosures.
Is notarization always required?
Not always. Requirement depends on recipient and state law. If a notary or witnesses are requested by the receiving authority, follow the specific jurisdictional rules or use RON where accepted.
What if the name does not match records?
Correct the name to match legal or corporate records or attach a certified explanation. Mismatched names can invalidate the declaration for official purposes.
How long should I retain the signed copy?
Retain per the longest applicable rule: IRS three-year baseline, HIPAA six years, and sector-specific statutes. When in doubt, keep records for seven years and consult counsel.
Can an agent sign on behalf of a company?
Yes, with written authorization such as a power of attorney or corporate resolution. Attach proof of authority and ensure the eSignature workflow records the agent's identity.
What happens after submission?
The recipient may accept the declaration, request supporting documents, or require an amended filing. Keep communication records and track any follow-up deadlines.

be ready to get more

Join over 28 million airSlate SignNow users

Sign Now