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INTERNAL CONTROL TRAINING CERTIFICATION
FOR ELECTED OFFICIALS,APPOINTEES,AND EMPLOYEES
I, I Y1 0, 01" ?2 , the duly elected, appointed, or employed
(print name)
0"i i I'�, 01 i for rsolg yi Ili 20lic,2, J } certify that I
(position or title) (political subdivision)
received the following training concerning internal controls standards and procedures as required
by Ind. Code § 5-11-1-27(g)(2):
Title of Training Time Spent
Date: `
Signature
* This certification may be printed, signed, and retained in paper form or electronically. If
signed electronically, the elected official, appointee, or employee must designate his or her
signature by typing the last four(4) digits of their Social Security number in the signature line.