Sworn Written Statement for Claimant Accounting Support
Complete the following sections based on the information you were requested to prepare and submit on behalf of the claimant. If you need more space to complete this Sworn Written Statement (“Statement”), attach additional pages and they will be incorporated into this document.
A. CLAIMANT INFORMATION
Name:

Last Name or Full Name of Business

First

Middle Initial

Larry

Hardee

Deepwater Horizon Settlement Program Claimant Number:

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SSN or ITIN

Social Security Number:

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Individual Taxpayer Identification Number:

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EIN

Employer Identification Number:

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Street

Current
Address:

P.O. Box 1380
City

State

Zip Code

Lynn Haven

FL

32444

B. PREPARER INFORMATION
Check the box that applies to you. You must only select one:
I am a Certified Public Accountant.
I am an Enrolled Agent (31 U.S.C. §§ 330, 10.3(c)).
I am an individual with an IRS Preparer Tax Identification Number (PTIN).
I am under the direct supervision of a Certified Public Accountant, an Enrolled Agent, or an individual with an IRS
Preparer Tax Identification Number (PTIN).
If you indicate that you work under the direct supervision of a Certified Public Accountant, an Enrolled Agent, or an individual with an IRS Preparer Tax Identification Number (PTIN), your supervisor must also complete Section C.
Name:

Last

First

Garcia

Middle Initial

M

Andrew

Street

Address:

1100 Poydras St., 34th Floor
City

State

New Orleans
Telephone
Number:
Email
Address:
Accountant
Website (if available): SWS-38
v.2

Zip Code

LA

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garcia@legier.com