Attestation for an Annual Recertification Under Section 4(c) of the GENIUS Act
State: ___
Name of State payment stablecoin regulator: ___
Date of attestation: ___
[States may include a brief introduction here]
Reference table of changes:
[List each change to the State-level regulatory regime or any known significant changes in circumstances in its own row and attach relevant documentation and additional narrative descriptions]
| GENIUS Act section
| Brief description of change
| Corresponding
section of narrative
| Corresponding
supporting information
|
|---|
| [4(a)(1)(A)] | [State regulation relating to reserve assets was revised] | [Section X] | [Exhibit A]. |
Primary contacts: [Names, titles, email addresses, and phone numbers of at least two authorized officials of the State payment stablecoin regulator]
Certification: The undersigned hereby certifies and attests that:
1. The information contained in and attached to this attestation form is true and correct to the best of the undersigned's knowledge;
2. [The State payment stablecoin regulator] believes that the State-level regulatory regime for [State]:
a. __ has not materially changed and there have been no known significant changes in circumstances; or
b. __ has materially changed or there have been significant changes in circumstances.
3. [State payment stablecoin regulator] confirms the continuing accuracy of the initial certification submitted on __; and
4. The undersigned has the authority to submit this attestation and make representations on behalf of [State payment stablecoin regulator].
[Signature, Name, Title]
Attached:
[Narrative]
[Exhibits]