Any person who gives information required in a report or otherwise required for such purpose knowing or having reason to believe that the information is false or who shall forge, or, without authority, sign any evidence of proof of financial responsibility for the future or who files or offers for filing any such evidence of proof knowing or having reason to believe that it is forged or signed without authority, shall be fined not more than one thousand dollars ($1,000) or imprisoned for not more than one (1) year, or both.