EMPLOYEE CERTIFICATION
OF PER DIEM AND RIG PAY SUBSTANTIATION REQUIREMENTS

EMPLOYEE CERTIFICATION OF PER DIEM AND RIG PAY SUBSTANTIATION REQUIREMENTS

  • (Print Full Name)
  • Represent the following to Frontier Environmental, Inc.:
  • 1.My Permanent residence location and tax home as defined by the IRS is:
  • 2.I perform a small portion (less than 10%) of my business within the vicinity of my permanent home when residing atmy permanent home. I understand any expense reimbursement for the time spent within the vicinity of my permanenthome is to be included in taxable income on my personal income tax return. 3.That I incur duplicate expenses because my business requires me to be away from my permanent home or incur rigexpenses in the course of performing my job duties. 4.Members of my family (marital or lineal) reside at my permanent home, or if I am single, I use my permanent homefrequently for lodging. 5.That the intent of this assignment, located at various job sites in Ohio, Pennsylvania and West Virginia is to betemporary.
  • FURTHERMORE, BY SIGNING BELOW, I ACKNOWLEDGE THAT THE ABOVE STATEMENTS ARE RELIED ON BY FRONTIER ENVIRONMENTAL, INC. FOR THE PURPOSE OF REMITTING PER DIEM AND RIG PAY ALLOWANCES, AND I HOLD HARMLESS FRONTIER ENVIRONMENTAL, INC. FROM ANY PENALTIES, BACK TAXES OR INTEREST THAT MAY RESULT DUE TO ANY CHANGES IN MY RESIDENCE OR ASSIGNMENT THAT MAKE UNTRUE OR FALSE THE STATEMENTS MADE ABOVE, OR AS A RESULT OF ANY INTERNAL REVENUE SERVICE TAXPAYER COMPLIANCE EXAMS. I ALSO ACKNOWLEDGE THAT IF THE REPRESENTATION CONTAINED HEREIN CHANGES, CEASES TO EXIST AND/OR THE ASSIGNMENT EXCEEDS A PERIOD OF 12 MONTHS, I WILL NOTIFY THE COMPANY IMMEDIATELY AND PROVIDE A NEW CERTIFICATION.
  • Employee

  • Date Format: MM slash DD slash YYYY
  • Frontier Witness

  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • *Document must be witnessed by an authorized representative of Frontier Environmental, Inc.*