Filing false affidavit or diploma; misrepresentation or concealment.

Any person who, in order to influence action by the board: (a) knowingly files a false or forged affidavit with the board; (b) files as his own a diploma or license issued to another; or (c) in any manner misrepresents or conceals his true name or former place of residence is guilty of a misdemeanor and, upon conviction, must be fined not more than one thousand dollars or imprisoned not more than six months or both.