State of California



AFFADAVIT

COPY CERTIFICATION BY DOCUMENT CUSTODIAN

The state of California does not allow notaries to certify copies of vital documents, Certified copies of birth, fetal, death, and marriage records can be made only by the State Registrar, by a duly appointed and acting local registrar during their term of office, and a county recorder. For an official certified copy of this or any document, you must obtain one from the institution that holds and maintains such records.

I, ________________________________________________, do solemnly swear (or affirm) under the

(Document custodian)

Penalty of perjury that the attached copy of __________________________________________________

_____________________________________________________________________________________

is a true, correct and accurate copy of the original document in my possession or control.

____________________________________________

(Signature of Document Custodian)

|A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this |

|certificate is attached, and not the truthfulness, accuracy, or validity of that document. |

State of California

County of ______________________

Subscribed and sworn to (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 (seal)

OPTIONAL INFORMATION

Document Type and description_____________________________________________________________

_______________________________________________________________________________________

Original Document Date: ________________

Number of Pages_______

Document in a Foreign Language ______ _________________________________

Identification ____________________

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