## Form 1—Certificate under subsection 8ZG(2) (subregulation 7(1)) COMMONWEALTH OF AUSTRALIA Taxation Administration Act 1953 CERTIFICATE UNDER SUBSECTION 8ZG(2) I, , the (title of officer issuing the certificate) of the (name and location of court), pursuant to subsection 8ZG(2) of the Taxation Administration Act 1953, hereby certify that on (date) the court, acting under (relevant provision) of the (relevant taxation law), ordered (name and address of relevant person) to pay $ to the Commissioner of Taxation. Dated (Signature)

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