Copy Certification by Document Custodian

 

       I, ______________________________________, hereby swear (or affirm) that the attached                          (Name of Document Custodian)    

        reproduction of _____________________________________________________________                                                                            (Description of Document)       

                                                                    ________________________________________________________________________              

       is a true & exact copy of the original document.

 

      __________________________________________________

                                                           (Signature of Document Custodian)

 

 

           State of California

           County of _____________________

            Subscribed and sworn (or affirmed) before me on this _______day of  ___________________, 20____

             by ________________________________________________________________________________

             __________________________________________________________________________________,       
       

            proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me.            

           

 

                                          __________________________                                                                                                                                                  (Signature of Notary Public)          

                                                                                                                           (Notary Seal)                                         

                     

  Optional  Information

Description of Attached Document:                                                                                                                                                                          Title or Type of Document:_________________________________________________________________________________

  _____________________________________________________________________________________________________

_____________________________________________________________________________________________________   

Document Date:____________                                  Number of Pages:_____________

    Other information:

 

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