Blank certification of business records form with document inventory appendix

EFTA00193160¶

CERTIFICATION OF BUSINESS RECORDS¶

I, the undersigned,___, declare that I am: employed by/associated with ___in the position of ___and by reason of my position am authorized and qualified to make this declaration.¶

In my employment with the above-named bank/company I am familiar with the business records it maintains. The above-named bank/company maintains records of its business which are:¶

1. made at or near the time of the occurrence of the matters set forth therein, by, or from information transmitted by, a person with knowledge of those matters;

2. kept in the course of regularly conducted business activity; and

3. made by the regularly conducted activity as a regular practice.

Among the records so maintained are the attached records itemized in Appendix A, Inventory of Documents.¶

I. declare under penalty of perjury that the foregoing is true and correct.¶

Date of execution: ___¶

Place of execution: ,¶

Signature: ___¶

EFTA00193161¶

APPENDIX A¶

DOCUMENT INVENTORY¶

The documents submitted are as follows:¶

Signature of Records Custodian:¶