Copy Certification By Document Custodian printable pdf download

Copy Certification By Document Custodian

Copy Certification by Document Custodian

STATE OF ____________________

COUNTY OF ____________________

Before me, the undersigned authority, personally appeared ____________________________,

(Affiant), who first being duly sworn by me, under penalty of perjury, deposed as follows:

1. My name is __________________________________________. I am over the age of

18 and fully competent to make this affidavit. The facts stated herein are true and correct

and are based on my personal knowledge.

2. I am the custodian of the records for ___________________________, kept at address

_____________________________________________________________________.

3. My capacity as records custodian is as: _____________________________________.

[individual, business owner/officer/manager, secretary, school/university officer, attorney,

accountant, bookkeeper, trustee, agent, government officer/agent, other]

4. Attached hereto are ______ pages of records, described as follows:

_____________________________________________________________________

_____________________________________________________________________.

[document title, type, description, date, ID #, signer, issuing agency, form number]

5. The said records attached hereto are exact duplicates of the originals, and are true,

correct and complete.

6. Other: ________________________________________________________________

_____________________________________________________________________.

_____________________________

Affiant’s Signature

SUBSCRIBED AND SWORN TO OR AFFIRMED before me on this _____ day of

_____________________, _________ by Affiant ___________________________________.

______________________________ [Seal]

Notary Public

_____________________

My commission expires

Copy Certification By Document Custodian