AFFIDAVIT OF RECORDS CUSTODIAN CERTIFYING RECORDS
PURSUANT TO RULES OF EVIDENCE 803(6) AND 902(11)
STATE OF TENNESSEE
)
)
COUNTY OF ________________ )
(County in which Entity is Located)
_________________________, having first been duly sworn according to law, makes oath upon his or her personal
(Name of Records Custodian)
knowledge as follows:
1.
I, ______________________, am the duly authorized custodian of the records for
(Name of Records Custodian)
[name of entity], and in such capacity, I have authority to certify the attached records.
2.
The attached records are true copies of all original records maintained by [name of entity]
regarding [name of relevant individual], (Date of Birth: --/--/----) that were requested by Records Acquisition
Services, Inc. in connection with the captioned matter.
3.
The attached records were kept in the course of the regularly conducted business activity of [name
of entity] and were prepared as a regular practice and custom.
4.
The attached records were prepared by the personnel of [name of entity] in the ordinary course of
business at or near the time of the act, condition, diagnosis, or event, reported thereon, and by a person or persons
with knowledge of and a business duty to record or transmit those matters.
AND FURTHER AFFIANT SAITH NOT.
________________________________
AFFIANT
Sworn and subscribed to before me
This ____ day of _________, 20____.
______________________________
Notary Public
My commission expires:__________