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Form 4192 - Certification Of Authenticity Of School District Records Of Regularly Conducted Activity

The School Board of Broward County, Florida

Records Retention

7720 W Oakland Park Blvd

Sunrise, FL 33351, (754) 321-3150

CERTIFICATION OF AUTHENTICITY OF SCHOOL DISTRICT RECORDS

OF REGULARLY CONDUCTED ACTIVITY

Pursuant to Rule 902(11), Federal Rules of Evidence and/or

Sections 90.902(10) or (11), 90.903, and 90.955, Florida Evidence Code

The undersigned declarant hereby declares, certifies, verifies or states under penalty of perjury the

following:

1. The declarant is a records custodian or other qualified person who can provide a written

declaration regarding the records of regularly conducted business activity which are the

subject of this certification;

2. The records of regularly conducted business activity (hereinafter “records”) which are the

subject of this certification are numbered/Bates stamped as

through

3. The records are originals or duplicate copies of domestic (United States) business records;

which are true and correct copies of the original record(s) prepared and/or maintained by

Broward County Public Schools.

4. The records were made at or near the time of the time of the occurrence of the matters set

forth by, or from information transmitted by, a person with knowledge of those matters;

5. The records were kept in the course of a regularly conducted business activity; and

6. The records were made as a regular practice in the course of regularly conducted business

activity

I hereby declare, certify or state, under penalty of perjury, that the foregoing is true and correct. Executed

on ______________ (date)

Signature of Declarant

Printed Name

Title

Department/School Name

Address

Telephone

Form #4192

New 7/11

Form 4192 - Certification Of Authenticity Of School District Records Of Regularly Conducted Activity