§ 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.