§ 4904. Unsworn falsification to authorities. (a) In general.--A person commits a misdemeanor of the second degree if, with intent to mislead a public servant in performing his official function, he: (1) makes any written false statement which he does not believe to be true; (2) submits or invites reliance on any writing which he knows to be forged, altered or otherwise lacking in authenticity; or (3) submits or invites reliance on any sample, specimen, map, boundary mark, or other object which he knows to be false. (b) Statements "under penalty".--A person commits a misdemeanor of the third degree if he makes a written false statement which he does not believe to be true, on or pursuant to a form bearing notice, authorized by law, to the effect that false statements made therein are punishable. (c) Perjury provisions applicable.--Section 4902(c) through (f) of this title (relating to perjury) applies to this section. (d) Penalty.--In addition to any other penalty that may be imposed, a person convicted under this section shall be sentenced to pay a fine of at least $1,000. (Nov. 29, 2006, P.L.1481, No.168, eff. 60 days) 2006 Amendment. Act 168 added subsec. (d). Cross References. Section 4904 is referred to in section 6116 of this title; section 2344 of Title 3 (Agriculture); section 1518 of Title 4 (Amusements); sections 102, 134, 8998 of Title 15 (Corporations and Unincorporated Associations); sections 761, 911, 3101 of Title 20 (Decedents, Estates and Fiduciaries); sections 4308.1, 5103, 5337, 6711 of Title 23 (Domestic Relations); section 1714 of Title 25 (Elections); section 4110 of Title 27 (Environmental Resources); sections 102, 1904, 5552, 5903 of Title 42 (Judiciary and Judicial Procedure); section 101 of Title 54 (Names).