[별지 제11호 서식(영문)] (98.12.31. 신설)

Issued No.					Settlement Period
					Immediately
□ COMPLETE PAYMENT CERTIFICATE OF LOCAL TAX □ COLLECTION DEFERMENT □ NON-TAXATION
Taxpayer	① Name in full (Name of rep.)		② K.I.D. No. (Cop. Reg. No.)
	③ Address (Head Office)	(Tel : )
④ Name of corporation
⑤ Location of corporation
⑥ Item of business
□ This is to certify that there is no delinquency in local tax payment in accordance with provision of Article 39, Paragraph 1 of The Local Tax Act as of the date of issuance of this certificate. □ This is to certify that there is no delinquency in local tax payment except for the collection-defered delinquency in accordance with the provision of Article 39, Paragraph 2 of The Local Tax Act as of the date of issuance of this certificate. □ This is to certify that there has been no taxation(excluding per capita rate of resident tax) in accordance with the provision of Article 39, Paragraph 1 of The Local Tax Act as of the data of issuance of this certificate. /S/ Official seal affixed.
※ This certificate is valid untill . . .(month/ day/ year) from the date of its issuance.
※ There is no Accompanying Document.				Fee
				according to the provision of Municipal Ordinance

21226-171111civil affair form                                                     210□×297□

Approved. 1998.9.23.                                                       (newsprint 54g/□)