Common use of CERTIFICATION STATEMENT Clause in Contracts

CERTIFICATION STATEMENT. I understand and agree that: 1. The effective date of this agreement is the later of (a) the date specified in Section I above and (b) the date permitted under the terms of the university’s 457(b) retirement plan. 2. I hereby authorize and direct the university to reduce my eligible compensation each pay period by the amount elected above and to remit such amount to the 457(b) provider elected above. I understand that my total deferrals for each calendar year cannot exceed the maximum set by the Internal Revenue Code and it is my responsibility to monitor compliance with these rules. 3. Contributions made under this Agreement are subject to Medicare taxes and may be subject to state and/or local taxes. 4. If I do not open a 457(b) account and provide a valid 457(b) account number in Section 2 above, this Agreement will be null and void. 5. This Agreement revokes and replaces any Salary Reduction Agreement which I previously signed, and shall remain in effect during my continued employment with the university unless a hardship distribution is obtained, the IRS limits are reached before December of the applicable plan year or this Agreement is superseded by a new Salary Reduction Agreement submitted by me. NOTE: If the amount you elected above will cause you to reach the annual maximum set by the Internal Revenue Code before December of a plan year, contributions will be stopped and a new election and Agreement will be required to begin contributions the following plan year. If the annual maximum set by the Internal Revenue Service is reached in December of a plan year, this election will continue automatically and a new election will not be required. 6. In the event of an adverse ruling by the Internal Revenue Service concerning my or the university’s federal income tax liability arising out of my election to participate in the university’s 457(b) Retirement Plan, it will be my responsibility to satisfy any federal income tax deficiency, including interest and penalties, assessed against me or the university. 7. This Agreement is subject to the terms and conditions of the university’s 457(b) Retirement Plan.

CERTIFICATION STATEMENT. I understand and agree andagree that: 1. The effective date of this agreement is the later of (a) the date specified in Section I above and (b) the date permitted under the terms of the university’s 457(b403(b) retirement plan. 2. I hereby authorize and direct the university to reduce my eligible compensation each pay period by the amount elected above and to remit such amount to the 457(b403(b) provider elected above. I understand that my total deferrals for each calendar year cannot exceed the maximum set by the Internal Revenue Code and it is my responsibility to monitor compliance with these rules. 3. Contributions made under this Agreement are subject to Medicare taxes and may be subject to state and/or local taxes. 4. If I do not open a 457(b403(b) account and provide a valid 457(b403(b) account number in Section 2 above, this Agreement will be null and void. 5. This Agreement revokes and replaces any Salary Reduction Agreement which I previously signedsubmitted, and shall remain in effect during my continued employment with the university unless a hardship distribution is obtained, the IRS limits are reached before December of the applicable plan year or this Agreement is superseded by a new Salary Reduction Agreement submitted by me. NOTE: If the amount you elected above will cause you to reach the annual maximum set by the Internal Revenue Code before December of a plan year, contributions will be stopped and a new election and Agreement will be required to begin contributions the following plan begincontributionsthefollowingplan year. If the annual maximum set by the Internal Revenue Service is reached in December of a plan year, this election will continue automatically and a new election will not be required.Service 6. In the event of an adverse ruling by the Internal Revenue Service concerning my or the university’s federal income tax liability arising out of my election to participate in the university’s 457(b403(b) Retirement Plan, it will be my responsibility to satisfy any federal income tax deficiency, including interest and penalties, assessed against me or the university. 7. This Agreement is subject to the terms and conditions of the university’s 457(b403(b) Retirement Plan. Signature Date Return completed form to: Office of Human Resources, Room ▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ or fax to ▇▇▇-▇▇▇-▇▇▇▇. Retain a copy for your records.

CERTIFICATION STATEMENT. I understand and agree andagree that: 1. The effective date of this agreement is the later of (a) the date specified in Section I above and (b) the date permitted under the terms of the university’s 457(b) retirement plan. 2. I hereby authorize and direct the university to reduce my eligible compensation each pay period by the amount elected above and to remit such amount to the 457(b) provider elected above. I understand that my total deferrals for each calendar year cannot exceed the maximum set by the Internal Revenue Code and it is my responsibility to monitor compliance with these rules. 3. Contributions made under this Agreement are subject to Medicare taxes and may be subject to state and/or local taxes. 4. If I do not open a 457(b) account and provide a valid 457(b) account number in Section 2 above, this Agreement will be null and void. 5. This Agreement revokes and replaces any Salary Reduction Agreement which I previously signedsubmitted, and shall remain in effect during my continued employment with the university unless a hardship distribution is obtained, the IRS limits are reached before December of the applicable plan year or this Agreement is superseded by a new Salary Reduction Agreement submitted by me. NOTE: If the amount you elected above will cause you to reach the annual maximum set by the Internal Revenue Code before December of a plan year, contributions will be stopped and a new election and Agreement will be required to begin contributions the following plan begincontributionsthefollowingplan year. If the annual maximum set by the Internal Revenue Service is reached in December of a plan year, this election will continue automatically and a new election will not be required.Service 6. In the event of an adverse ruling by the Internal Revenue Service concerning my or the university’s federal income tax liability arising out of my election to participate in the university’s 457(b) Retirement Plan, it will be my responsibility to satisfy any federal income tax deficiency, including interest and penalties, assessed against me or the university. 7. This Agreement is subject to the terms and conditions of the university’s 457(b) Retirement Plan. Signature Date Return completed form to: Office of Human Resources, Room 016, ▇▇▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ or fax to ▇▇▇-▇▇▇-▇▇▇▇. Retain a copy for your records.