12 CFR Appendix B to Part 1522: Appendix B to Part 1522—Attestation for an Annual Recertification Under Section 4(c) of the GENIUS Act

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]