Manufacturer�s Certification Statement

							                   Manufacturer’s Certification Statement
               For the American reinvestment & recovery act of 2009


Thermo-Kool of Alaska Inc. certifies that the insulation materials listed below are “Eligible Building
Envelope Components” that qualify for the Federal Tax Credit for existing homes which is allowed under
section 1121 of the American reinvestment & recovery act of 2009.



Arctic Fiber Cellulose Insulation


Under penalties of perjury, I declare that I have examined this certification statement, and to the best of my
knowledge and belief, the facts are true and complete.




Dick Divelbiss
President
Thermo-Kool of Alaska Inc.



Homeowner’s Records

Taxpayer Name__________________________________________________

Social Security Number____________________________________________

Primary Residence________________________________________________

________________________________________________________________

Product__________________________________________________________

Price Paid for Product_______________________________________________

Date Purchased____________________________________________________

Date Installed at Primary Residence____________________________________