Alaska Certificate of Qualifying Veteran
Form 
6326

                       Complete and provide to employer

Social Security Number Name of Veteran                                                          Telephone Number

Mailing Address                                                   City                          State        Zip Code

Purpose of form:  The certificate of qualifying veteran declares that the person qualifies as a veteran under AS 43.20.048 for purposes 
of the employer claiming a veteran employment tax credit
Required attachment:  You must attach a copy of your federal Certificate of Discharge (DD-214 or other)

I certify the following (check the box of each item that applies):

     I served in and was honorably discharged from one of the following:

     the armed forces of the United States, including a reserve unit of the armed forces of the United States

     Alaska Territorial Guard, the Alaska Army National Guard, the Alaska Air National Guard, or the Alaska Naval Militia

     I have been unemployed for at least 4 weeks immediately preceding the date employment begins

     I am a disabled veteran because I am one of the following:

     a veteran who is entitled to compensation under laws administered by the United States Department of Veterans Affairs

     a person who was honorably discharged or released from activity duty because of service-connected disability

     a person who was disabled in the line of duty while serving in the Alaska Territorial Guard

Veteran’s sworn statement:  The undersigned understands that the fraudulent use of this certificate will subject all guilty parties, upon 
conviction, to a fine not to exceed $25,000 or imprisonment for not more than three years, or both, under AS 43.05.290.

I swear under penalty of perjury that I have examined this certificate and to the best of my knowledge and belief, it is a true, correct and 
complete statement.
Veteran’s Signature                                                                             Date

                                                                                                       0405-6326  Rev 01/01/14 
                                                        6326:01/01/14