§ 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).