I, _________________________________________, hereby certify and affirm in writing that I am _________________________ of _____________________________________ and that I am custodian of the records that are attached hereto. The copies of the records are exact, full, true and correct copies of records pertaining to the case of _____________________________. All of which I hereby certify and affirm, under oath, this day of ____________________, 20______.
Custodian of Records
Ala. Admin. Code r. 545-X-3-.09
Author: Alabama Medical Licensure Commission
Statutory Authority:Code of Ala. 1975, § 41-22-13.