Form 08-4009c - First Aid Card Copy Certification

State of Alaska

Department of Community and Economic Development

Division of Occupational Licensing

P.O. Box 110806

Juneau, AK 99811-0806

Telephone: (907) 465-2543 Fax: (907) 465-2974

E-mail: license@dced.state.ak.us

Present this form along with your photocopy to the Notary or Postmaster. Once complete,

be sure to attach this form to your photocopy of the First Aid Card.

FIRST AID CARD COPY CERTIFICATION

State of

Judicial District

, hereby swear (or affirm) that the

(Name of Custodian of original document - Applicant)

attached reproduction of

is a true,

(Description of original document with number of pages)

correct, and complete photocopy of a document in my possession.

Signature of Custodian of Original Documents

Address of Custodian of Original Documents:

SUBSCRIBED AND SWORN (or AFFIRMED) TO before me this ______ day of

SEAL

Notary Public

My Commission Expires:

POSTMASTER STAMP

08-4009c (Rev. 10/00)

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Parent category: Legal