Certification of records custodian form
[DOCX File]Certification of Records Form - Attorney General of Kentucky
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CERTIFICATION OF AUTHENTICATION OF RECORDS. I, _____, Custodian of Records for _____, hereby certify that the attached documents are true and correct copies of records maintained by _____. These records were made at or near the time of the occurrence of the matters set forth in these records, by a person with knowledge of those matters; these ...
[DOCX File]Borrower in Custody Program - Third Party Custodian ...
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I, the undersigned, certify that I am an authorized representative for (custodian name). I further certify that I have reviewed the above responses, and that the responses are true and accurate and are in compliance with all the terms and conditions of the Agreements for Third Party Custodian to Hold Collateral executed by [custodian name] and delivered to the Federal Reserve Bank of San ...
[DOC File]COPY CERTIFICATION BY DOCUMENT CUSTODIAN
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COPY DECLARATION BY DOCUMENT CUSTODIAN. Date: _____ I, _____, hereby declare that the attached reproduction of _____ is a copy of the original document in my possession or control. DETAILS OF ORIGINAL DOCUMENT(S) Document Number(s) Date(s) issued. Issued by. Pages attached (excluding any Apostille or Authentications) ... COPY CERTIFICATION BY ...
[DOC File]Certification of Healthcare Records
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Patient: Dates of Service From: To I, , Medical/Chiropractic Billing Clerk / Custodian for Dr. of hereby certify that the documents attached to this certificate consisting of pages constitute an accurate, legible and complete copy of the medical/chiropractic billings for for the dates of service shown above.
[DOCX File]Certification of Healthcare Records
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Certification . Form to Accompany Requested . Health. C. are Records. Patient: Records From: to . I, , Healthcare Records Clerk / Custodian for Dr. of hereby certify that the documents attached to this certificate consisting of pages constitute an accurate, legible and complete copy of the healthcare records of the patient named above for the ...
[DOCX File](700)-110 Certification of Documents
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The Legal Custodian forwards the certification package, consisting of the completed form, documents to be certified, and pertinent background information, including the document(s) prompting the certification and any specific certification requirements, to the Office of Chief Counsel.
[DOC File]Department:
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Please sign this certificate and return to the RI State Archives and Public Records Administration. If faxing, please provide a return fax number. I certify that I have reviewed the above listed records and authorize their destruction. Department Head or Records Custodian: _____ Date: _____
[DOC File]CERTIFICATION OF PUBLIC RECORDS - Kentucky
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CERTIFICATION OF RECORDS. I, (CFO or CEO)_____, as custodian of records for the _____(name of company)_____, do hereby certify that the attached copies (list type of documents if known) are true and correct copies of the originals and are official records of the _____(name of company)_____ received and compiled in the ordinary course of ...
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