GreenFiber Corporate Office

2500 Distribution Street, Suite 200
Charlotte, NC 28203
800.228.0024 / www.greenfiber.com

MANUFACTURER’S CERTIFICATION STATEMENT
FOR THE AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009
 
US GreenFiber, LLC certifies the following GreenFiber insulation products are “Eligible Building Envelope Components” that qualify for the Federal Tax
Credit for existing homes allowed under section 1121 of the American Recovery and Reinvestment Act of 2009:

Weight Product # Product Description

22.55 lb INS551LD GreenFiber™ Loose-fill Natural Fiber Insulation
22.55 lb INS416LD Do-It-Best® Loose-fill Blow-in Insulation
22.55 lb INSTOP Tasco® Loose-fill Blow-in Insulation
25 lb INS535LD GreenFiber™ Loose-fill Natural Fiber Insulation
25 lb INS530 GreenFiber™ Stabilized Floor Natural Fiber Insulation
28 lb INSRT3011 Redi-Safe Loose-fill Blow-in Insulation
30 lb INS500 GreenFiber™ Stabilized Natural Fiber Insulation
30 lb INS735 GreenFiber™ Stabilized Borate Natural Fiber Insulation
30 lb INS730 GreenFiber™ Stabilized Floor Natural Fiber Insulation
30 lb INS510LD GreenFiber™ Loose-fill Natural Fiber Insulation
30 lb INS760LD GreenFiber™ All Borate Loose-fill Natural Fiber Insulation

The American Recovery and Reinvestment Act (ARRA) of 2009 permits homeowners a 30% federal tax credit of up to $1500 for the addition of
GreenFiber Insulation to their home. This tax credit applies to qualified energy efficient products purchased and installed between February 17, 2009
and December 31, 2010. This credit is applicable for the 2009-2010 taxable years.

A taxpayer is not required to attach this certification statement to the return on which the credit is claimed. Income tax regulations require taxpayers
maintain records sufficient to establish the entitlement to any credit claimed. This certification statement and installation instructions are provided in
printable form on the www.greenfiber.com website.

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,
correct, and complete.

 
William Blalock, Vice President, Sales and Marketing
US GreenFiber, LLC

US GreenFiber (USGF) does not provide architectural, inspection or engineering services and disclaims any responsibility with respect thereto. USGF does not guarantee, warrant or attempt to determine
whether a building structure, design or the use of materials therein complies with any applicable codes, standards, guidelines or standards of workmanship. The user maintains the full and complete
responsibility to comply with all codes, laws and regulations applicable to the safe and proper use, handling and installation of the product and should consult with an architect and/or engineer for all
construction and design related questions. The information contained herein is believed to be accurate as of the time of preparation. However, USGF makes no warranty concerning the accuracy of this
information. USGF will not be liable for claims relating to the use of information contained herein, regardless of whether it is claimed that the information or recommendations are inaccurate, incomplete or
incorrect.
PM-6.3-154 Rev E 03/09
 
   
 
HOMEOWNER’S CERTIFICATION: 
The following product(s) has (have) been installed in the primary residence of the following taxpayer: 

Homeowner's Name: SSN:

Primary Residence Address:

Products Installed:

Price Paid for Products: Date Purchased: / / Date Installed: / /