Affidavit Help:

Please print or type. Submission of illegible materials will result in return of the affidavit to the applicant. The applicant should retain a copy of the affidavit for his or her records. The checklist below is designed to ensure your affidavit is approved.

e-Sign Affidavit:

Summary Checklist:

• Every line of the affidavit is filled-out. Sole proprietors should fill out each signature line on Pages 2-3.
• All signatures on the affidavit must be wet-ink, originals.
• All signatures must be notarized within the attest boxes.
• All pages (minus the instructions) must be mailed to the WDEQ. Fax or email is not acceptable. 

Page 1:

• “STATE OF” and “COUNTY OF” refer to the State and County where the affidavit is notarized.
• The applicant completes this page. The first and last name and the name of the company are prepopulated.
• This page is signed by the applicant and must need to be notarized. 

Page 2:

• This page is completed by company/government owners/representatives who are authorizing ENV-ITE users to sign on behalf of the company/government.
• Authorized Program, Name, Title (if available), Employed by/working on behalf of will be filled in automatically with the information provided in ENV-ITE.
• Address, Phone Number, and Email should be of the person who signs up to use ENV-ITE.
• The company/government representatives who are authorizing the applicant to sign and submit permit applications and data on behalf of the company/government entity need to have their names printed on this page as well as their organization. This process continues on Page 3.

Page 3:

• Similar to the bottom of Page 2, the company/government representatives who are authorizing the applicant to sign and submit permit applications and data on behalf of the company/government entity need to have notarized signatures on this page.

Editor Affidaivt:

Summary Checklist:

• All signatures on the affidavit must be wet-ink, originals.
• All pages (minus the instructions) must be mailed to the WDEQ. Fax or email is not acceptable.

Page 1:

• “STATE OF” and “COUNTY OF” refer to the State and County where the affidavit is signed by applicant.
• The first and last name and the name of the company are prepopulated. The applicant completes the first Signature and Print Name and Title lines.
• The company/government representatives who are authorizing the applicant to prepare permit applications and data on behalf of the company / government entity need to print their names on the I/We… line. The number of representatives required to authorize this act depends on the type of organization or government entity (see details on Page 2 below and Appendix D of the ENVITE walkthrough guide).
• Authorized Program, Name, Title (if available), Employed by/working on behalf of will be filled in automatically with the information provided in ENV-ITE.
• Address, Phone Number, and Email should be of the person who signs up to use ENV-ITE.

Page 2:

• The company/government representatives who are authorizing the applicant to prepare permit applications and data on behalf of the company/government entity need to sign and print their names and titles on this page.

Sample Affidavit:

eSign: Sample eSgin Affidavit

Edit: Sample edit Affidavit

Signatory Requirements: 

The signature requirements may vary depending on the WDEQ application selected.

Water Quality Division:

WYPDES applications, which includes eDMR, have to comply with 40 CFR § 122.22 – Signatories to permit applications and reports (applicable to State programs, see § 123.25). 

(a) Applications. All permit applications shall be signed as follows: 

(1) For a corporation. By a responsible corporate officer. For the purpose of this section, a responsible corporate officer means: (i) A president, secretary, treasurer, or vice-president of the corporation in charge of a principal business function, or any other person who performs similar policy- or decision- making functions for the corporation, or (ii) the manager of one or more manufacturing, production, or operating facilities, provided, the manager is authorized to make management decisions which govern the operation of the regulated facility including having the explicit or implicit duty of making major capital investment recommendations, and initiating and directing other comprehensive measures to assure long term environmental compliance with environmental laws and regulations; the manager can ensure that the necessary systems are established or actions taken to gather complete and accurate information for permit application requirements; and where authority to sign documents has been assigned or delegated to the manager in accordance with corporate procedures. 

Note: EPA does not require specific assignments or delegations of authority to responsible corporate officers identified in § 122.22(a)(1)(i) . The Agency will presume that these responsible corporate officers have the requisite authority to sign permit applications unless the corporation has notified the Director to the contrary. Corporate procedures governing authority to sign permit applications may provide for assignment or delegation to applicable corporate positions under § 122.22(a)(1)(ii) rather than to specific individuals. 

(2) For a partnership or sole proprietorship. By a general partner or the proprietor, respectively; or 

(3) For a municipality, State, Federal, or other public agency. By either a principal executive officer or ranking elected official. For purposes of this section, a principal executive officer of a Federal agency includes: (i) The chief executive officer of the agency, or (ii) a senior executive officer having responsibility for the overall operations of a principal geographic unit of the agency (e.g., Regional Administrators of EPA). This space was intentionally left blank. 

(b) All reports required by permits, and other information requested by the Director shall be signed by a person described in paragraph (a) of this section, or by a duly authorized representative of that person. A person is a duly authorized representative only if: 

(1) The authorization is made in writing by a person described in paragraph (a) of this section; 

(2) The authorization specifies either an individual or a position having responsibility for the overall operation of the regulated facility or activity such as the position of plant manager, operator of a well or a well field, superintendent, position of equivalent responsibility, or an individual or position having overall responsibility for environmental matters for the company, (A duly authorized representative may thus be either a named individual or any individual occupying a named position.) and, 

(3) The written authorization is submitted to the Director. 

(c) Changes to authorization. If an authorization under paragraph (b) of this section is no longer accurate because a different individual or position has responsibility for the overall operation of the facility, a new authorization satisfying the requirements of paragraph (b) of this section must be submitted to the Director prior to or together with any reports, information, or applications to be signed by an authorized representative. 

(d) Certification. Any person signing a document under paragraph (a) or (b) of this section shall make the following certification: 

I certify under penalty of law that this document and all attachments were prepared under my direction or supervision in accordance with a system designed to assure that qualified personnel properly gather and evaluate the information submitted. Based on my inquiry of the person or persons who manage the system, or those persons directly responsible for gathering the information, the information submitted is, to the best of my knowledge and belief, true, accurate, and complete. I am aware that there are significant penalties for submitting false information, including the possibility of fine and imprisonment for knowing violations. 

(Clean Water Act (33 U.S.C. 1251 et seq.), Safe Drinking Water Act (42 U.S.C. 300f et seq.), Clean Air Act (42 U.S.C. 7401 et seq.), Resource Conservation and Recovery Act (42 U.S.C. 6901 et seq.)) 

[48 FR 14153, Apr. 1, 1983, as amended at 48 FR 39619, Sept. 1, 1983; 49 FR 38047, Sept. 29, 1984; 50 FR 6941, Feb. 19, 1985; 55 FR 48063, Nov. 16, 1990; 65 FR 30907, May 15, 2000] 

Land Quality Division:
For detailed signature requirements please contact the MIDAS Application Administrator, Vanessa Romero, 307-777-7052

Air Quality Division:
For detailed signature requirements please contact the IMPACT Application Administrator, Zachary Mangin 307-777-6282